Taxonomy codes

Taxonomy codes are administrative codes set up for health care providers to classify the type of provider and the region of specialization. Each taxonomy code is a unique alphanumeric code of ten characters that allows providers to define their specialty at the claim level. At both the individual provider and organizational provider level, taxonomy codes are assigned. Taxonomy codes have three distinct levels: Level I is the provider type, Level II is Classification, and Level III is the Specialization Area.

A provider may have more than one code for taxonomy. Registering all available taxonomy codes with NPPES and using the correct taxonomy code to represent the relevant specialty when filing claims is essential. This would help to manage claims more precisely and promptly.

Taxonomy Codes Required on Professional Claims

Effective January 1, 2020, taxonomy codes will be required when submitting professional claims for all HAP and HAP Empowered business lines. It is compliant with the National Standardized Billing Standards and is essential for the correct and timely processing of claims.

As a provider, do I need to know my taxonomy code?

Yes, if you want to become a Medicare provider.

You must first participate in the Medicare program to become a Medicare provider and file Medicare claims. It would be best if you had an NPI to enroll. And to get an NPI, the taxonomy code representing your classification and specialization will need to be included in your submission.

Where do I find my taxonomy code?

Use the National Uniform Claim Committee (NUCC) code setlist to find the taxonomy code which describes your provider category, classification, or specialization most closely.

How to Submit Taxonomy Codes on Your Claims

In Segment PRV03 and Loop 2000A for the billing level and Section PRV03 and Loop 2420A for the rendering level, taxonomy codes on electronic claim submissions with the ASC X12N 837P and 837I format are placed. The taxonomy code should be marked with the qualifier ‘ZZ’ in the shaded portion of box 24i for paper CMS-1500 professional statements.

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