HL7 v2.5.1 Vocabulary
0.1.0 - ci-build

HL7 v2.5.1 Vocabulary, published by HL7/FO. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/frankoemig/hl7.v2.terminology.v251/ and changes regularly. See the Directory of published versions

## : Modifier Edit Code (2.5.1 - 1.0.0) - XML Representation

Active as of 2026-01-27

Raw xml | Download

    <CodeSystem xmlns="http://hl7.org/fhir">
      <id value="cms-OCEModifierEditCode-cs"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><ul><li>Include all codes defined in <a href="CodeSystem-cms-OCEModifierEditCode-cs.html"><code>http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEModifierEditCode-cs</code></a></li></ul></div>
      </text>
      <extension
                 url="http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-v2versionCreated">
        <valueString value="2.5.1"/>
      </extension>
      <extension
                 url="http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-versionHistory">
        <valueString value="generate correct history somehow"/>
      </extension>
      <extension
                 url="http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-tableNo">
        <valueString value="0467"/>
      </extension>
      <url
           value="http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEModifierEditCode-cs"/>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.6.301.10"/>
      </identifier>
      <version value="1.0.0"/>
      <name value="Cms-OCEModifierEditCode-cs"/>
      <title value="Modifier Edit Code (2.5.1 - 1.0.0)"/>
      <status value="active"/>
      <experimental value="true"/>
      <date value="2026-01-27T19:29:18+00:00"/>
      <publisher value="HL7/FO"/>
      <contact>
        <name value="HL7/FO"/>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org"/>
        </telecom>
      </contact>
      <description
                   value="The OPPS functionality of the Integrated Outpatient Code Editor (I/OCE) software was developed for the implementation of the Medicare outpatient prospective payment system mandated by the 1997 Balanced Budget Act. CMS released the proposed OPPS rules using the Ambulatory Payment Classification (APC) system in the September 8, 1998 Federal Register. Final regulations were published in the April 7, 2000 Federal Register and the system became effective for Medicare on August 1, 2000.  Used in HL7 Version 2.x messaging in the GP1 segment.

    The APC-based OPPS developed by CMS is the outpatient equivalent of the inpatient, DRG-based PPS. The APC system establishes groups of covered services so that the services within each group are comparable clinically and with respect to the use of resources.

    Hospitals are required to use HCPCS when billing for outpatient services.

    The OCE not only identifies individual errors but also indicates what actions should be taken and the reasons why these actions are necessary. In order to accommodate this functionality, the OCE is structured to return lists of edit numbers. This structure facilitates the linkage between the actions being taken, the reasons for the actions and the information on the claim (e.g., a specific diagnosis) that caused the action.

    In general, the OCE performs all functions that require specific reference to HCPCS codes, HCPCS modifiers and ICD-10-CM diagnosis codes (ICD-9-CM diagnosis codes for historical claims with From Dates prior to 10/1/2015). Since these coding systems are complex and annually updated, the centralization of the direct reference to these codes and modifiers in a single program reduces effort and reduces the chance of inconsistent processing.

    This is a CMS maintained list of edits: Please see the following for additional information:
    •	https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/index.html
    •	https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/Background.htmlC
    •	https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs.html"/>
      <copyright value="HL7 Inc., 2026"/>
      <caseSensitive value="true"/>
      <compositional value="false"/>
      <content value="complete"/>
      <property>
        <code value="versionIntroduced"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionIntroduced"/>
        <description value="version when was this code introduced"/>
        <type value="string"/>
      </property>
      <property>
        <code value="versionDeprecated"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionDeprecated"/>
        <description value="version when was this code deprecated"/>
        <type value="string"/>
      </property>
      <property>
        <code value="status"/>
        <uri value="http://hl7.org/fhir/concept-properties#status"/>
        <description
                     value="A code that indicates the status of the concept. Typical values are active, experimental, deprecated, and retired"/>
        <type value="code"/>
      </property>
      <property>
        <code value="comment"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#comment"/>
        <description
                     value="A string that provides additional detail pertinent to the use or understanding of the concept"/>
        <type value="string"/>
      </property>
      <property>
        <code value="usage"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#usage"/>
        <description value="usage notes for this code"/>
        <type value="string"/>
      </property>
      <property>
        <code value="modified"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#modified"/>
        <description value="date of last modification"/>
        <type value="dateTime"/>
      </property>
      <concept>
        <code value="0"/>
        <display value="Modifier does NOT exist"/>
        <definition value="Modifier does NOT exist"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="1"/>
        <display value="Modifier present, no errors"/>
        <definition value="Modifier present, no errors"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="2"/>
        <display value="Modifier invalid"/>
        <definition value="Modifier invalid"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="3"/>
        <display value="Modifier NOT approved for ASC/HOPD use"/>
        <definition value="Modifier NOT approved for ASC/HOPD use"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="4"/>
        <display
                 value="Modifier approved for ASC/HOPD use, inappropriate for code"/>
        <definition
                    value="Modifier approved for ASC/HOPD use, inappropriate for code"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="U"/>
        <display value="Modifier edit code unknown"/>
        <definition value="Modifier edit code unknown"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
    </CodeSystem>