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Medicare, Taxonomy Codes and Crossover

The issue of taxonomy codes is getting a lot of attention from providers who are trying to fulfill billing instruction for crossover payers. Taxonomy codes are not required by Medicare but can be helpful in determining matches for a National Provider Identifier (NPI). If you send a taxonomy code, you must follow the rules that apply to taxonomy. If your electronic claim has a taxonomy code, and your claim is crossed over to the next payer, that taxonomy code will be sent. If the taxonomy code is not present on the electronic claim, no taxonomy code will be sent to the next payer. Taxonomy codes are not crossed over on paper claims submitted to Medicare.

A taxonomy code is a 10-digit alpha numeric (ex: 208D00000X) that represents a provider's specialty. The taxonomy code set is maintained by the National Uniform Claim Committee (NUCC) of the American Medical Association (AMA). The complete list of taxonomy codes is available on the Washington Publishing Website.

The taxonomy code is intended to allow a payer to be able to identify a provider's specialty and price a claim appropriately. The specialty information is especially useful in situations to assist the payer in identifying the legacy provider number in the payers system.

Helpful Taxonomy Information:

  • A taxonomy code is not required by Medicare;
  • A taxonomy code is reported in the PRV03;
  • If a taxonomy code is present, it must be valid;
  • If you send a rendering provider loop, include the PRV at the 2310B level. If no rendering provider loop, include the PRV at the 2000A level;
  • If a taxonomy code is sent at both the billing and rendering level, the batch will reject in prepass editing.

The use of the taxonomy code depends on the payer's requirements and format of the electronic claim.

If you need additional information you may also contact WPS EDI at (866) 518-3285.