Update to the Healthcare Provider Taxonomy Codes (HPTC) April 1, 2011

Provider Types Affected
Providers who bill carriers including DME MAC.
Provider Action Needed: Impact to You

CMS has released the summary of changes reflected in the Health Care Provider Taxonomy Code (HPTC) list. Medicare carriers and DME MACs will update their HPTC tables with this new version effective on April 1, 2011.
What You Need to Know
The Health Insurance Portability and Accountability Act (HIPAA) requires that submitted data, which is part of a named code set, be valid data from that code set. Claims accepted with invalid data are non-compliant.
What You Need to Do
Please review the information included here and stay current on all HIPAA requirements to assure timely processing of your claims.
Under HIPAA, code sets that characterizes a general administrative situation, rather than a medical condition or service, are referred to as non-clinical or non-medical code sets. The provider taxonomy code set is an external non-medical data code set designed for use in classifying health care providers according to provider type or practitioner specialty in an electronic environment, specifically within the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) health care transaction.
HIPAA requires that submitted data, which is part of a named code set, must be valid data from that code set. The health care provider taxonomy is a named code set in the 837 professional implementation guide, thus carriers must validate the inbound taxonomy codes against their internal HPTC tables.
The HPTCs are updated twice per year, in April and October. The summary of changes effective April 1, 2011, is noted in the table below.
New Codes
Modified Codes


The HPTC code list is available from the Washington Publishing Company at www.wpc-edi.com.
If you have any questions regarding this information, please contact the Palmetto GBA EDI Department associated with your contract at the toll-free telephone number listed below.
  • J11 Part A and HHH: (866) 749-4301
  • Part B (Ohio and West Virginia): (866) 308-5438
  • Part B (South Carolina): (866) 749-4301
Railroad Medicare: (866) 749-4301