Code
|
Display
|
Definition
|
pcpov
|
Primary Care Visit to Treat an Injury or Illness |
Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services. |
specialistov
|
Specialist Office Visit |
Covered healthcare service rendered to a patient by a specialty provider. |
mlpov
|
Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional |
Benefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner. |
outpatient
|
Outpatient Facility Fee (e.g., Ambulatory Surgery Center) |
Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission. |
outpatstx
|
Outpatient Surgery Physician/Surgical Services |
Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient. |
hospserv
|
Hospice Services |
Benefit plan covers hospice services. |
routinedental
|
Routine Dental Services (Adult) |
Benefit plan covers routine dental services. |
infertilitytx
|
Infertility Treatment |
Benefit plan covers eligible infertility treatment services. |
ltnhc
|
Long-Term/Custodial Nursing Home Care |
Long-Term/Custodial Nursing Home Care. |
privatenurse
|
Private-Duty Nursing |
Private-Duty Nursing. |
routineeye
|
Routine Eye Exam (Adult) |
Routine Eye Exam (Adult). |
ucservice
|
Urgent Care Centers or Facilities |
Urgent Care Centers or Facilities. |
homehealth
|
Home Health |
Home health services insurance coverage. |
erservice
|
Emergency Room Services |
Emergency Room Services. |
ambulance
|
Emergency Room Services |
Emergency Room Services. |
inpatienthospital
|
Inpatient Hospital Services (e.g., Hospital Stay) |
A person who is hospitalized for at least one night to receive treatment or participate in a study. |
inpatientprovider
|
Inpatient Physician and Surgical Services |
A healthcare provider who is delivering healthcare services in a hospital environment. |
bariatricsurg
|
Bariatric Surgery |
Bariatric surgery service Skilled nursing service (qualifier value). |
cosmeticsurg
|
Cosmetic Surgery |
Cosmetic surgery service Skilled nursing service (qualifier value). |
skillednursing
|
Skilled Nursing Facility |
Skilled nursing service (qualifier value). |
ppnatalcare
|
Prenatal and Postnatal Care |
Prenatal and Postnatal services. |
maternitycare
|
Delivery and All Inpatient Services for Maternity Care |
All maternity care services. |
menthlthoutp
|
Mental/Behavioral Health Outpatient Services |
Mental health service delivered in an outpatient setting. |
menthlthinp
|
Mental/Behavioral Health Inpatient Services |
Mental health service delivered in an hospital or inpatient facility setting. |
sadoutp
|
Substance Abuse Disorder Outpatient Services |
Substance abuse related services delivered in a outpatient setting. |
sadinp
|
Substance Abuse Disorder Inpatient Services |
Substance abuse related services delivered in a inpatient setting. |
drggenric
|
Generic Drugs |
Generic drugs eligible benefits. |
drgbrand
|
Preferred Brand Drugs |
Preferred brand drugs eligible benefits. |
drgnonpreferred
|
Non-Preferred Brand Drugs |
Non-Preferred drugs brands eligible benefits. |
drgspecialty
|
Specialty Drugs |
Benefit plan covers specialty drugs. |
rehaboutp
|
Outpatient Rehabilitation Services |
Benefit plan covers outpatient rehabilitation services. |
servicehablitation
|
Habilitation Services |
Habilitation Services. |
chiro
|
Chiropractic Care |
Benefit plan covers chiropractor eligible benefits. |
dme
|
Durable Medical Equipment |
Benefit plan covers Durable medical equipment eligible benefits. |
hearingaids
|
Hearing Aids |
Benefit plan covers hearing aids. |
imgctpetmri
|
Imaging (CT/PET Scans, MRIs) |
Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services. |
prev
|
Preventive Care/Screening/Immunization |
Routine healthcare services to prevent health related problems eligible benefits. |
rtnpod
|
Routine Foot Care |
Routine Foot Care. |
acupuncture
|
Acupuncture |
Benefit plan covers acupuncture treatment. |
weightloss
|
Weight Loss Programs |
Benefit plan covers weight loss services eligible benefits. |
rtneyechld
|
Routine Eye Exam for Children |
Routine eye exam for children eligible benefits. |
glasseschld
|
Eye Glasses for Children |
Eye glasses children eligible benefits. |
rtndntlchld
|
Dental Check-Up for Children |
Dental Check-Up for Children. |
speachthpy
|
Rehabilitative Speech Therapy |
Benefit plan covers rehabilitative speech therapy eligible benefits. |
rehaboccandpt
|
Rehabilitative Occupational and Rehabilitative Physical Therapy |
Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits. |
wellbaby
|
Well Baby Visits and Care |
Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency. |
laboutp
|
Laboratory Outpatient and Professional Services |
Benefit plan covers laboratory testing and related professional services received as outpatient. |
imagingdx
|
X-rays and Diagnostic Imaging |
Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases. |
dntlbaschld
|
Basic Dental Care – Child |
Benefit plan covers diagnostic basic dental care. |
orthochld
|
Orthodontia – Child |
Benefit plan covers orthodontia for children. |
dntlmajchld
|
Major Dental Care – Child |
Benefit plan covers major dental care for children. |
dntlbasadlt
|
Basic Dental Care – Adult |
Benefit plan covers basic dental care for adults. |
orthodadlt
|
Orthodontia – Adult |
Benefits plan covers services provided that are required for orthodontic purposes for an adult. |
dntlmajadlt
|
Major Dental Care – Adult |
Benefit plan covers major dental care for adult. |
abortion
|
Abortion for Which Public Funding is Prohibited |
Benefit plan covers services for abortion for which public funding is prohibited. |
transplant
|
Transplant |
Benefit plan covers transplant related services. |
accdntl
|
Accidental Dental |
Benefit plan covers dental care services related to an accident. |
dialysis
|
Dialysis |
The plan benefit covers services used to treat end stage renal disease. |
testallrgy
|
Allergy Testing |
The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities. |
chemotherapy
|
Chemotherapy |
The plan benefits cover services the use of drugs and approved chemicals to treat disease. |
radiation
|
Radiation |
The plan benefits cover services the use radiation to treat disease. |
edudiab
|
Diabetes Education |
The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes. |
prosthetic
|
Prosthetic Devices |
Plan benefit covers services related to prosthesis devices. |
infusiontx
|
Infusion Therapy |
Plan benefit covers services related to infusion therapy. |
tmjtx
|
Treatment for Temporomandibular Joint Disorders |
Plan benefit covers services related to treatment of Temporomandibular Joint disorder. |
nutrition
|
Nutritional Counseling |
Nutritional Counseling. |
reconsurg
|
Reconstructive Surgery |
Plan benefit covers services related to reconstructive surgery. |