|
STC Code |
Description of STC Code |
|
STC Code |
Description of STC Code |
|
1 |
Medical Care |
|
BI |
Nursery Room and Board |
|
2 |
Surgical |
|
BK |
Orthopedic |
|
3 |
Consultation |
|
BL |
Cardiac |
|
4 |
Diagnostic X-Ray |
|
BM |
Lymphatic |
|
5 |
Diagnostic Lab |
|
BN |
Gastrointestinal |
|
6 |
Radiation Therapy |
|
BP |
Endocrine |
|
7 |
Anesthesia |
|
BQ |
Neurology |
|
8 |
Surgical Assistance |
|
BT |
Gynecological |
|
10 |
Blood |
|
BU |
Obstetrical |
|
11 |
Durable Medical Equipment Used |
|
BV |
Obstetrical/Gynecological |
|
12 |
Durable Medical Equipment Purchased |
|
BY |
Physician Visit - Sick |
|
14 |
Renal Supplies |
|
BZ |
Physician Visit - Well |
|
17 |
Pre-Admission Testing |
|
C1 |
Coronary Care |
|
18 |
Durable Medical Equipment Rental |
|
CK |
Screening X-ray |
|
19 |
Pneumonia Vaccine |
|
CL |
Screening laboratory |
|
20 |
Second Surgical Opinion |
|
CM |
Mammogram, High Risk Patient |
|
21 |
Third Surgical Opinion |
|
CN |
Mammogram, Low Risk Patient |
|
22 |
Social Work |
|
CO |
Flu Vaccination |
|
23 |
Diagnostic Dental |
|
CP |
Eyewear Accessories |
|
24 |
Periodontics |
|
CQ |
Case Management |
|
25 |
Restorative |
|
DG |
Dermatology |
|
26 |
Endodontics |
|
DM |
Durable Medical Equipment |
|
27 |
Maxillofacial Prosthetics |
|
DS |
Diabetic Supplies |
|
28 |
Adjunctive Dental Services |
|
E0 |
Applied Behavioral Analysis Therapy |
|
30 |
Health Benefit Plan Coverage |
|
E1 |
Non-Medical Equipment (non DME) |
|
32 |
Plan Waiting Period |
|
E2 |
Psychiatric Emergency |
|
33 |
Chiropractic |
|
E3 |
Step Down Unit |
|
35 |
Dental Care |
|
E4 |
Skilled Nursing Facility Head Level of Care |
|
36 |
Dental Crowns |
|
E5 |
Skilled Nursing Facility Ventilator Level of Care |
|
37 |
Dental Accident |
|
E6 |
Level of Care 1 |
|
38 |
Orthodontics |
|
E7 |
Level of Care 2 |
|
39 |
Prosthodontics |
|
E8 |
Level of Care 3 |
|
40 |
Oral Surgery |
|
E9 |
Level of Care 4 |
|
41 |
Preventive Dental |
|
E10 |
Radiographs |
|
42 |
Home Health Care |
|
E11 |
Diagnostic Imaging |
|
43 |
Home Health Prescriptions |
|
E14 |
Fixed Prosthodontics |
|
45 |
Hospice |
|
E15 |
Removable Prosthodontics |
|
46 |
Respite Care |
|
E16 |
Intraoral Images - Complete Series |
|
47 |
Hospitalization |
|
E17 |
Oral Evaluation |
|
49 |
Hospital - Room and Board |
|
E18 |
Dental Prophylaxis |
|
54 |
Long Term Care |
|
E19 |
Panoramic Images |
|
55 |
Major Medical |
|
E20 |
Sealants |
|
56 |
Medically Related Transportation |
|
E21 |
Fluoride Treatments |
|
60 |
General Benefits |
|
E22 |
Dental Implants |
|
61 |
In-vitro Fertilization |
|
E23 |
Temporomandibular Joint Dysfunction |
|
62 |
MRI Scan |
|
E25 |
Long Term Care Pharmacy |
|
63 |
Donor Procedures |
|
E26 |
Comprehensive Medication Therapy Management Review |
|
64 |
Acupuncture |
|
E27 |
Targeted Medication Therapy Management Review |
|
65 |
Newborn Care |
|
E28 |
Dietary/Nutritional Services |
|
66 |
Pathology |
|
E33 |
Intensive Cardiac Rehabilitation |
|
67 |
Smoking Cessation |
|
E36 |
Convenience Care |
|
68 |
Well Baby Care |
|
E37 |
Telemedicine |
|
69 |
Maternity |
|
E38 |
Pharmacist Services |
|
70 |
Transplants |
|
E39 |
Diabetic Education |
|
71 |
Audiology |
|
E40 |
Early Intervention |
|
72 |
Inhalation Therapy |
|
EA |
Preventive Services |
|
73 |
Diagnostic Medical |
|
EB |
Specialty Pharmacy |
|
74 |
Private Duty Nursing |
|
EC |
Durable Medical Equipment New |
|
75 |
Prosthetics |
|
ED |
CAT Scan |
|
76 |
Dialysis |
|
EE |
Ophthalmology |
|
77 |
Otology |
|
EF |
Contact Lenses |
|
78 |
Chemotherapy |
|
F1 |
Medical Coverage |
|
79 |
Allergy Testing |
|
F2 |
Social Work Coverage |
|
80 |
Immunizations |
|
F3 |
Dental Coverage |
|
81 |
Routine Physical |
|
F4 |
Hearing Coverage |
|
82 |
Family Planning |
|
F5 |
Prescription Drug Coverage |
|
83 |
Infertility |
|
F6 |
Vision Coverage |
|
84 |
Abortion |
|
F7 |
Orthodontia Coverage |
|
85 |
HIV - AIDS Treatment |
|
F8 |
Mental Health Coverage |
|
86 |
Emergency Services |
|
GF |
Generic Prescription Drug - Formulary |
|
87 |
Cancer Treatment |
|
GN |
Generic Prescription Drug - Non-Formulary |
|
88 |
Retail/Independent Pharmacy |
|
GY |
Allergy |
|
89 |
Free Standing Prescription Drug |
|
IC |
Intensive Care |
|
90 |
Mail Order Pharmacy |
|
MH |
Mental Health |
|
91 |
Brand Name Prescription Drug |
|
NI |
Neonatal Intensive Care |
|
92 |
Generic Prescription Drug |
|
ON |
Oncology |
|
93 |
Podiatry |
|
PE |
Positron Emission Tomography (PET) Scan |
|
A4 |
Psychiatric |
|
PT |
Physical Therapy |
|
A6 |
Psychotherapy |
|
PU |
Pulmonary |
|
A7 |
Psychiatric - Inpatient |
|
RN |
Renal |
|
A8 |
Psychiatric - Outpatient |
|
RT |
Residential Psychiatric Treatment |
|
A9 |
Rehabilitation |
|
SMH |
Serious Mental Health |
|
AB |
Rehabilitation - Inpatient |
|
TC |
Transitional Care |
|
AC |
Rehabilitation - Outpatient |
|
TN |
Transitional Nursery Care |
|
AD |
Occupational Therapy |
|
UC |
Urgent Care |
|
AE |
Physical Medicine |
|
|
|
|
AF |
Speech Therapy |
|
|
|
|
AG |
Skilled Nursing Care |
|
|
|
|
AI |
Substance Abuse |
|
|
|
|
AJ |
Alcoholism Treatment |
|
|
|
|
AK |
Drug Addiction |
|
|
|
|
AL |
Optometry |
|
|
|
|
AM |
Frames |
|
|
|
|
AO |
Lenses |
|
|
|
|
AP |
Routine Eye Exam |
|
|
|
|
AQ |
Nonmedically Necessary Physical (These physicals are required by other entities e.g., insurance application, pilot license, employment or school) |
|
|
|
|
AR |
Experimental Drug Therapy |
|
|
|
|
B1 |
Burn Care |
|
|
|
|
B2 |
Brand Name Prescription Drug - Formulary |
|
|
|
|
B3 |
Brand Name Prescription Drug - Non-Formulary |
|
|
|
|
BA |
Independent Medical Evaluation |
|
|
|
|
BB |
Psychiatric Treatment Partial Hospitalization |
|
|
|
|
BC |
Day Care (Psychiatric) |
|
|
|
|
BD |
Cognitive Therapy |
|
|
|
|
BE |
Massage Therapy |
|
|
|
|
BF |
Pulmonary Rehabilitation |
|
|
|
|
BG |
Cardiac Rehabilitation |
|
|
|
|
BH |
Pediatric |
|
|
|