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You are here: Administrative Simplification > Regulations > Transactions & Code Sets

HIPAA Administrative Simplification - Transactions & Code Sets


Modifications to HIPAA Transactions and Code Set Standards Finalized - The Final Rule adopting changes to the HIPAA Electronic Transactions and Code Set Standards will be published in the Federal Register on February 20, 2003. This final rule modifies a number of the electronic transactions and code sets adopted as national standards under HIPAA, and eliminates the NDC code set as the standard for all providers except retail pharmacies. It does not adopt a standard reporting drugs and biologics on non-retail pharmacy transactions. Click here to view the Final Rule (PDF 367K). The modifications are published as Addenda to the ASC X12N Implementation Guides and are available through the Washington Publishing Company at www.wpc-edi.com.

Final Rule


Proposed Rule

Implementation Guides

Code Sets


  1. Health Care Common Procedure Coding System (HCPCS)
    This file contains the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions. These codes, which are established by CMS’s Alpha-Numeric Editorial Panel, primarily represent items and supplies and nonphysician services not covered by the American Medical Association’s CPT-4 codes. This file does not contain the American Medical Association’s CPT-4 codes. CPT-4 codes can be purchased from the American Medical Association at 1-800-621-8335.
    Alpha-Numeric HCPCS File (ANHCPC03.ZIP - 836Kb)
  2. International Classification of Diseases, 9th revision, Clinical Modification ICD-9-CM Volumes 1 & 2 (diagnosis codes) are maintained by the National Center for Health Statistics, Centers for Disease Control (CDC) in HHS. The diagnosis link is:
    www.cdc.gov/nchs/icd9.htm
  3. International Classification of Diseases, 9th revision, Clinical Modification ICD-9-CM Volume 3 (procedures) are maintained by CMS. The CMS procedure link is:
    www.cms.hhs.gov/paymentsystems/icd9

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Last Modified on Friday, September 17, 2004