Health Insurance Prospective Payment System (HIPPS) Codes

This site contains information related to the use and maintenance of the Health Insurance Prospective Payment System (HIPPS) codeset. The Centers for Medicare and Medicaid Services (CMS) are named in the ASC X12 837 Institutional Claim Implementation Guide as the code source for HIPPS codes.

Contact HIPPS: If you have questions regarding the HIPPS codeset that are not answered in the information below, write to HIPPS@cms.hhs.gov.

• Definition and Uses of HIPPS Codes (PDF Format 251kb) - provides background on the application of the codes and defines how codes for various payment settings are constructed.
• HIPPS Code Master List (ZIP Format 168kb) - an Excel spreadsheet that provides a complete list of all valid HIPPS codes, with their effective dates, payment settings and code definitions.
• Change Request Process (PDF Format 93kb) - describes the steps necessary to request a modification in the HIPPS codeset and the CMS code approval process.
• Change Request History (ZIP Format 3kb) - an Excel spreadsheet that documents the disposition of all change requests received as of the most recent HIPPS code update.

Related CMS Links:

For information regarding other Medicare Electronic Data Interchange (EDI) activities, go to: http://cms.hhs.gov/providers/edi/.

CMS also maintains the Healthcare Common Procedure Coding System (HCPCS). For information regarding HCPCS, go to: http://cms.hhs.gov/medicare/hcpcs/default.asp.