Here’s a tip that may make a difference in how quickly your commercial and Medicare Advantage claims are paid: submit your taxonomy codes in both your paper and electronic claims submissions. Taxonomy codes allow your claims to be priced according to the Centers for Medicare & Medicaid Services’ (CMS) established rates.
Submission of taxonomy codes is required for all Medicare claims submissions, and it is highly recommended for commercial claims.
Taxonomy codes are administrative codes that identify your provider type and specialization. A taxonomy code is a unique, 10-character, alphanumeric code that identifies your specialty at the claim level.
Information required in claims submissions are:
Provider data element |
Inclusion condition |
EDI location |
Paper claim location |
Institutional claims |
|||
Billing Provider Taxonomy Code |
Always include billing provider taxonomy code. |
2000A PRV01, 02, 03 |
81a with B3 qualifier |
Attending Provider Taxonomy Code |
Include if attending provider differs from 2000A PRV01, 02, 03 |
2310A PRV01, 02, 03 |
81b with B3 qualifier |
Professional claims |
|||
Billing Provider Taxonomy Code |
Always include billing provider taxonomy code. |
2000A PRV01, 02, 03 |
33b |
Rendering Provider Taxonomy Code (claim level) |
Include if rendering provider differs from 2000A PRV01, 02, 03 |
2310B PRV01, 02, 03 |
24J - enter taxonomy code preceded by qualifier ‘ZZ’ |
Rendering Provider Taxonomy Code (service level) |
Include if service line rendering provider differs from 2310B PRV01, 02, 03 |
2420A PRV01, 02, 03 |
CMS updates and publishes the Health Care Provider Taxonomy Code Set twice a year. Current codes can be found on the CMS website.
Checking your taxonomy code in NPPES
Please make sure your taxonomy code in the National Plan and Provider Enumeration System (NPPES) database is accurate.
Here’s what you need to do:
- Go to npiregistry.cms.hhs.gov and look up your NPI.
- Click on the NPI number to view the full record, including the provider taxonomy codes. If the taxonomy codes are accurate, you’re all set.
- If the codes are incorrect, sign into nppes.cms.hhs.gov/NPPES/Welcome.do to manage and update your NPI and taxonomy code. The taxonomy code should be updated automatically.
