Durable Medical Equipment - Healthcare Provider Taxonomy Codes October 2010 Update
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Durable Medical Equipment - Healthcare Provider Taxonomy Codes October 2010 Update
The Health Insurance Portability and Accountability Act (HIPAA) require that covered entities comply with the requirements in the electronic transaction format implementation guides adopted as national standards.  The X12 837 Professional Implementation Guide used for durable medical equipment (DME) claims requires the use of valid codes contained in the Healthcare Provider Taxonomy Codes (HPTC) set when there is a need to report provider type or physician, practitioner, or supplier specialty for a claim.
The HPTC set is maintained by the National Uniform Claim Committee (NUCC) for standardized classification of health care providers. The NUCC updates the code set twice a year with changes effective April 1 and October 1.
Valid HPTCs are those codes approved by the NUCC for current use.  Terminated codes are not approved for use after a specific date and newly approved codes are not approved for use prior to the effective date of the code set update in which each new code first appears.  Although the NUCC generally posts their updates on the Washington Publishing Company (WPC) website three months prior to the effective date, changes are not effective until April 1 or October 1 as indicated in each update.  Specialty and/or provider type codes issued by any entity other than the NUCC are not valid and Medicare would be guilty of noncompliance with HIPAA if Medicare contractors accepted claims that contain invalid HPTCs.
The taxonomy code is not required for processing Medicare claims.  However, if a taxonomy code is submitted, it must be valid according to the HPTC code set.  The HPTC code set is named in the 837 professional implementation guide, thus CEDI must validate the inbound taxonomy codes against this HPTC maintained code source.
The HPTC list is available from the WPC.  To view the October 2010 changes, visit the WPC website at http://www.wpc-edi.com/codes/taxonomy, then select "New Codes” for a listing of new HPTCs or "Modifications” for a listing of modified HPTCs.
Contact the CEDI Help Desk at 866-311-9184 or by e-mail at ngs.cedihelpdesk@wellpoint.com if you have questions.
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