Provider's Guide to Medicare Part A and HHH Bill Code Structures

Published 05/16/2025

Why Is a Provider Transaction Access Number Important?

“The Provider Transaction Access Number (PTAN), often referred to as a Medicare Provider Number, Medicare Billing Number, CMS Certification Number (CCN), or Medicare "legacy" number, is a generic term for any number other than the National Provider Identifier (NPI) that is used by a provider to bill the Medicare program.

"The National Provider Identifier (NPI) is the standard unique health identifier for health care providers and suppliers and is assigned by the National Plan and Provider Enumeration System (NPPES). Medicare healthcare providers, except for organ procurement organizations, must obtain an NPI prior to enrolling in Medicare or before submitting a change to your existing Medicare enrollment information. Applying for an NPI is a process separate from Medicare enrollment.” (Medicare Enrollment Application — Institutional Providers — PDF.)

Providers will need this number for authentication (verifies the identity of all providers authorized to receive the requested information) when calling the Provider Contact Center (PCC) and for all correspondence as a Medicare provider. Medicare Part A providers and suppliers are issued a six-digit provider number/PTAN/CCN:

  • The first two digits identify the State in which the provider is located
  • The last four digits identify the type of facility, sequentially, from within the appropriate CCN range

For more information, navigate to State Operations Manual, Section 2779A1 — CCN for Medicare Providers (PDF).

Type of Bill

“This four-digit alphanumeric code gives three specific pieces of information after a leading zero. CMS will ignore the leading zero. CMS will continue to process three specific pieces of information. The second digit identifies the type of facility. The third classifies the type of care. The fourth indicates the sequence of this bill in this particular episode of care. It is referred to as a ‘frequency’ code. Codes used for Medicare claims are available from Medicare contractors. Codes are also available from the NUBC (www.nubc.org) via the NUBC’s Official UB-04 Data Specifications Manual.” (CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 25, Section 75.1 — PDF).

Medicare Part A Bill Type Codes

Table 1. Medicare Part A Bill Type Codes.
Type of Bill Description Jurisdiction Specific
011X Inpatient Hospital — Part A  
012X Inpatient Hospital — Part B (Ancillary)  
013X Hospital — Outpatient  
014X Hospital — Other Part B (Non-Patient)  
018X Hospital — Swing Bed  
021X Skilled Nursing Facility (SNF) — Inpatient  
022X SNF — Inpatient Part B  
023X SNF — Outpatient  
028X SNF — Swing Bed  
032X Home Health (HH) —Part B or Part A/B Coverage Jurisdiction M Only
034X HH — Outpatient, Physical Therapy, Speech-Language Therapy or Occupational Therapy Jurisdiction M Only
041X Religious Non-Medical Healthcare Institution Jurisdiction J Only
071X Rural Health Clinic — Outpatient  
072X End Stage Renal Disease — ESRD  
074X Outpatient Rehabilitation Facility (ORF)  
075X Comprehensive Outpatient Rehabilitation Facility (CORF)  
076X Community Mental Health Centers (CMHCs)  
077X Federally Qualified Health Center (FQHC)  
081X Hospice — Non-Hospital Based Jurisdiction M Only
082X Hospice — Hospital-Based Jurisdiction M Only
083X Ambulatory Surgical/Surgery Center (ASC) — Hospital Outpatient  
085X Critical Access Hospital  

Code Structure

  • Second Digit: Type of Facility (The Centers for Medicare & Medicaid Services (CMS) will process this as the first digit)
  • Third Digit: Bill Classification (Except Clinics and Special Facilities) (CMS will process this as the second digit)
  • Third Digit: Classification (Clinics Only) (CMS will process this as the second digit)
  • Third Digit: Classification (Special Facilities Only) (CMS will process this as the second digit)
  • Fourth Digit: Frequency — Definition (CMS will process this as the third digit)

The Type of Bill 085x will be used on the table below, as an example. Please study the position of each digit to learn how CMS classifies the various Medicare Types of Bills.

Table 2. Code Structure.
First Digit Second Digit Third Digit Fourth Digit
0 8 5 X
CMS will ignore the leading zero Type of Facility (CMS will process this as the first digit) Type of Care Frequency — Definition (CMS will process this as the third digit)
CMS will continue to process three specific pieces of information   Bill Classification (except clinics and special facilities; CMS will process this as the second digit)  
    Classification (clinics only — CMS will process this as the second digit)  
    Classification (special facilities only — CMS will process this as the second digit)  

Second Digit: Type of Facility

Note: CMS processes this as the first digit.

Table 3. Second Digit: Type of Facility.

Second Digit Position

Description
1 Hospital
2 SNF
3 HH
4 Religious Non-Medical (Hospital)
5 Religious Non-Medical (Extended Care) Structure
6 Intermediate Care
7 Clinic or Hospital-Based Renal Dialysis Facility (requires special information in second digit below)
8 Special Facility or Hospital ASC Surgery (requires special information in second digit below)
9 Reserved for National Assignment

Type of Care

Third Digit: Bill Classification (Except Clinics and Special Facilities)

Note: CMS will process this as the second digit.

Table 4. Third Digit: Bill Classification (Except Clinics and Special Facilities)
Third Digit Position Description
1 Inpatient (Part A)
2 Inpatient (Part B) — For HH aide non-Prospective Payment System (PPS) claims, includes HHA visits under a Part B plan of treatment; for HHA PPS claims, indicates a Request for Anticipated Payment (RAP). Note: For HHA PPS claims, CMS determines from which Trust Fund payment is made. Therefore, there is no need to indicate Part A or Part B on the bill.
3 Outpatient (for non-PPS HHAs, includes HHA visits under a Part A plan of treatment and use of HHA Durable Medical Equipment under a Part A plan of treatment). For HHAs paid under PPS, CMS determines from which Trust Fund, Part A or Part B. Therefore, there is no need to indicate Part A or Part B on the bill.
4 Other (Part B) — Includes HHA medical and other health services not under a plan of treatment, hospital and SNF for diagnostic clinical laboratory services for “nonpatients,” and referenced diagnostic services. For HHAs under PPS, indicates an osteoporosis claim. Note: 24X is discontinued effective 10/1/05.
5 Intermediate Care — Level I
6 Intermediate Care — Level II
7 Reserved for national assignment (discontinued effective Oct. 1, 2005)
8 Swing Bed (may be used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement)
9 Reserved for National Assignment

Third Digit: Classification (Clinics Only)

Note: CMS will process this as the second digit.

Table 5. Third Digit: Classification (Clinics Only)

Third Digit Position

Description
1 Rural Health Clinic
2 Hospital-Based or Independent Renal Dialysis Facility
3 FQHC
4 ORF
5 CORF
6 CMHC
7–8 Reserved for National Assignment
9 Other

Third Digit: Classification (Special Facilities Only)

Note: CMS will process this as the second digit.

Table 6. Third Digit: Classification (Special Facilities Only).

Third Digit Position

Description
1 Hospice — Non-Hospital-Based
2 Hospice — Hospital-Based
3 ASC Services to Hospital Outpatients
4 Free-Standing Birthing Center
5 Critical Access Hospital
6–8 Reserved for National Assignment
9 Other

Fourth Digit: Frequency — Definition

The fourth digit indicates the sequence of this bill in this particular episode of care. It is referred to as a "frequency" code.

Note: CMS will process this as the third digit. Also, the list below is not all inclusive.

Table 7. Fourth Digit: Frequency — Definition.
Fourth Digit Position Terminology Definition
0 Non-Payment/Zero Claim

The provider uses this code when it does not anticipate payment from the payer for the bill but informs the payer about a period of non-payable confinement or termination of care. The "Through" date of this bill (FL 6) is the discharge date for this confinement, or termination of the plan of care.
1 Admit through Discharge Claims (admitted and discharged on the same day)

The provider uses this code for a bill encompassing an entire inpatient confinement or course of outpatient treatment for which it expects payment from the payer or which will update deductible for inpatient or Part B claims when Medicare is secondary to an employer group health plan.
2 Interim — First Claim

Used for the first of an expected series of bills for which utilization is chargeable or which will update inpatient deductible for the same confinement of course of treatment. For HHAs, used for the submission of original or replacement RAPs.
3 Interim — Continuing Claims (not valid for PPS bills)

Use this code when a bill for which utilization is chargeable for the same confinement or course of treatment has already been submitted and further bills are expected to be submitted later.
4 Interim — Last Claim (not valid for PPS bills)

This code is used for a bill for which utilization is chargeable, and which is the last of a series for this confinement or course of treatment. The "Through" date of this bill (FL 6) is the discharge for this treatment.
5 Late Charge Only Claim

When the provider submits late charges on bills to the Fiscal Intermediary (FI) as bill type XX5, these bills contain only additional charges.
7 Adjustment of Prior Paid Claim

This is used to correct a previously submitted bill. The provider applies this code to the corrected or "new" bill.
8 Void/Cancel of Prior Claim

The provider uses this code to indicate this bill is an exact duplicate of an incorrect bill previously submitted. A code "7" (Replacement of Prior Claim) is being submitted showing corrected information.
9 Final claim for a HH PPS Period

This code indicates the HH bill should be processed as a debit or credit adjustment to the request for anticipated payment
A Admission/Election Notice for Hospice

Used when the hospice or Religious Non-medical Health Care Institution is submitting Form CMS-1450 as an Admission Notice
B Hospice Termination/Revocation Notice

Used when the Form CMS-1450 is used as a notice of termination/revocation for a previously posted Hospice/Medicare Coordinated Care Demonstration/Religious Non-medical Health Care Institution election
C Hospice Change of Provider Notice

Used when Form CMS-1450 is used as a Notice of Change to the hospice provider
D Hospice Election Void/Cancel

Used when Form CMS-1450 is used as a Notice of a Void/Cancel of Hospice/Medicare Coordinated Care Demonstration/Religious Non-Medical Health Care Institution election
E Hospice Change of Ownership

Used when Form CMS-1450 is used as a Notice of Change in Ownership for the hospice.
F Beneficiary Initiated Adjustment Claim

Used to identify adjustments initiated by the beneficiary. For FI use only.
G Common Working File (CWF) Initiated Adjustment Claim

Used to identify adjustments initiated by CWF. For FI use only.
H CMS Initiated Adjustment Claim

Used to identify adjustments initiated by CMS. For FI use only.
I Medical Review Reconsideration Adjustment or FI Adjustment Claim (other than Quality Improvement Organization [QIO] or provider)

Used to identify adjustments initiated by the FI. For FI use only.
J Initiated Adjustment Claim/Other

Used to identify adjustments initiated by other entities. For FI use only.
K Office of Inspector General (OIG) Initiated Adjustment Claim

Used to identify adjustments initiated by OIG. For FI use only.
M Medicare Secondary Payment (MSP) Adjustment Claim

Used to identify adjustments initiated by MSP. For FI use only. Note: MSP takes precedence over other adjustment sources.
P QIO Adjustment Claim Used to identify an adjustment initiated as a result of a QIO review. For FI use only.
Q Reopening/Adjustment  

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