HL7 v2.6 Vocabulary
0.2.0 - ci-build

HL7 v2.6 Vocabulary, published by HL7/FO. This guide is not an authorized publication; it is the continuous build for version 0.2.0 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.v26/ and changes regularly. See the Directory of published versions

## ValueSet: OCE Edit Code (2.6 - 1.0.0) (Experimental)

Official URL: http://terminology.hl7.org/v2plusvocab/ValueSet/hl7VSOCEEditCode | Version: 1.0.0
Active as of 2026-03-13 | Computable Name: Hl7VSOCEEditCode
Other Identifiers: OID:2.16.840.1.113883.21.470, urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#http://terminology.hl7.org/v2plusvocab/ValueSet/v2-0458
Copyright/Legal: HL7 Inc., 2026

Value Set of codes that specify the edits that result from processing the HCPCS/CPT procedures for a record after evaluating all the codes, revenue codes, and modifiers.

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

### Logical Definition (CLD)

- Include all codes defined in `http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` version 📍1.0.0

### Expansion

Expansion performed internally based on codesystem OCE Edit Code (2.6 - 1.0.0) v1.0.0 (CodeSystem)

This value set contains 42 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 1 | Invalid diagnosis code | Invalid diagnosis code |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 10 | Non-covered service submitted for verification of denial (condition code 21 from header information on claim) | Non-covered service submitted for verification of denial (condition code 21 from header information on claim) |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 11 | Non-covered service submitted for FI review (condition code 20 from header information on claim) | Non-covered service submitted for FI review (condition code 20 from header information on claim) |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 12 | Questionable covered service | Questionable covered service |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 13 | Additional payment for service not provided by Medicare | Additional payment for service not provided by Medicare |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 14 | Code indicates a site of service not included in OPPS | Code indicates a site of service not included in OPPS |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 15 | Service unit out of range for procedure | Service unit out of range for procedure |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 16 | Multiple bilateral procedures without modifier 50 (see Appendix A) | Multiple bilateral procedures without modifier 50 (see Appendix A) |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 17 | Multiple bilateral procedures with modifier 50 (see Appendix A) | Multiple bilateral procedures with modifier 50 (see Appendix A) |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 18 | Inpatient procedure | Inpatient procedure |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 19 | Mutually exclusive procedure that is not allowed even if appropriate modifier present | Mutually exclusive procedure that is not allowed even if appropriate modifier present |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 2 | Diagnosis and age conflict | Diagnosis and age conflict |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 20 | Component of a comprehensive procedure that is not allowed even if appropriate modifier present | Component of a comprehensive procedure that is not allowed even if appropriate modifier present |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 21 | Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B) | Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B) |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 22 | Invalid modifier | Invalid modifier |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 23 | Invalid date | Invalid date |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 24 | Date out of OCE range | Date out of OCE range |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 25 | Invalid age | Invalid age |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 26 | Invalid sex | Invalid sex |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 27 | Only incidental services reported | Only incidental services reported |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 28 | Code not recognized by Medicare; alternate code for same service available | Code not recognized by Medicare; alternate code for same service available |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 29 | Partial hospitalization service for non-mental health diagnosis | Partial hospitalization service for non-mental health diagnosis |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 3 | Diagnosis and sex conflict | Diagnosis and sex conflict |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 30 | Insufficient services on day of partial hospitalization | Insufficient services on day of partial hospitalization |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 31 | Partial hospitalization on same day as ECT or type "T" procedure | Partial hospitalization on same day as ECT or type "T" procedure |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 32 | Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days | Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 33 | Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services | Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 34 | Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria | Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 35 | Only activity therapy and/or occupational therapy services provided | Only activity therapy and/or occupational therapy services provided |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 36 | Extensive mental health services provided on day of ECT or significant procedure | Extensive mental health services provided on day of ECT or significant procedure |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 37 | Terminated bilateral procedure or terminated procedure with units greater than one | Terminated bilateral procedure or terminated procedure with units greater than one |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 38 | Inconsistency between implanted device and implantation procedure | Inconsistency between implanted device and implantation procedure |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 39 | Mutually exclusive procedure that would be allowed if appropriate modifier were present | Mutually exclusive procedure that would be allowed if appropriate modifier were present |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 4 | Medicare secondary payer alert | Medicare secondary payer alert |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 40 | Component of a comprehensive procedure that would be allowed if appropriate modifier were present | Component of a comprehensive procedure that would be allowed if appropriate modifier were present |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 41 | Invalid revenue code | Invalid revenue code |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 42 | Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B) | Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B) |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 5 | E-code as reason for visit | E-code as reason for visit |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 6 | Invalid procedure code | Invalid procedure code |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 7 | Procedure and age conflict | Procedure and age conflict |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 8 | Procedure and sex conflict | Procedure and sex conflict |  |
`http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs` | 9 | Nov-covered service | Nov-covered service |  |

Explanation of the columns that may appear on this page:

Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System | The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code | The code (used as the code in the resource instance)
Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition | An explanation of the meaning of the concept
Comments | Additional notes about how to use the code