Page History

01

Not insured   

Patient has no insurance and is declared a charity write-off

02 

Not insured, self pay

Patient has no insurance and is declared responsible for charges

10

Insurance, NOS   

Type of insurance unknown or other than the types listed in codes 20, 31, 35, 5060-5668

20

Managed Care, HMO, PPO

An organized system of prepaid care for a group of enrollees usually within a defined geographic area

21 

Private Insurance:  Fee-for-service

An insurance plan that does not have a negotiated fee structure with the participating hospital

31

Medicaid 

State government administered insurance for persons who are uninsured, below the poverty level, or covered under entitlement programs

35 

Medicaid administered through a Managed Care Plan

State government administered insurance which is administered through a commercial Managed Care plan

60

Medicare without supplement, Medicare, NOS

Federal government funded insurance for persons who are retired or disabled, or over 65 years old

61 

Medicare with supplement

Patient has Medicare and another insurance to pay costs not covered by Medicare

62

Medicare administered through a Managed Care Plan

Patient enrolled in Medicare through a Managed Care Plan (e.g. HMO, PPO). The plan pays for all incurred costs

63

Medicare with private supplement

Patient has Medicare and private insurance to pay costs not covered by Medicare

64

Medicare with Medicaid eligibility

Federal government Medicare insurance with State Medicaid administered supplement

65

TRICARE (Formerly CHAMPUS)

Department of Defense program providing supplementary civilian-sector hospital and medical services to military dependents, retirees, and their dependents

66  

Military

Military personnel or their dependents who are treated at a military facility

67 

Veterans Affairs 

Veterans who are treated in Veterans Affairs facilities

68 

Indian/Public Health Service

Patient who receives care at an Indian Health Service facility and costs are reimbursed by the Indian Health Service.

99

 Insurance status unknown 

It is unknown from the patient’s medical record whether or not the patient is insured