More Information
The Health Care Provider Taxonomy code set is a collection of unique alphanumeric codes, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
The Health Care Provider Taxonomy code set allows a single provider (individual, group, or institution) to identify their specialty category. Providers may have one or more than one value associated to them. When determining what value or valuess to associate with a provider, the user needs to review the requirements of the trading partner with which the value(s) are being used.
Answers to the following questions are available by clicking the question
• How do I use the On-Line list?
• Where are they used?
• What do the Levels mean?
• How many categories are there?
• Does choosing a taxonomy code mean that I have met the licensure/certification
requirements for that provider?
• If the source of the definition for the provider code is a specific professional
organization or credentialing Board, do I have to have their certification in order to
choose the code?
• How are they maintained?
• Who maintains them?
• How do I request a change?
• When is the code list published?
• When was the last revision?
• Is there a revision summary?
• Are there other download formats?
• Can I get previous versions?
• Is there background information?
If using Internet Explorer, click on the Titles in the top frame to expand that node, or click the red text reading: Click Here to Expand List | Click terms below to expand/contract a section link to display the entire list. After you have expanded the list, you can search for specific text within the list by clicking the Edit menu on the toolbar, and then selecting Find (on this Page)... option.
Within the list are links labeled [more] — clicking one of those will display additional information about that node in the bottom frame.
EXAMPLE
Let's say you are loking for the Health Care Provider Taxonomy code set value for a general dentist. The list is displayed simply at first:
A general dentist is an "Individual" and clicking on the term "Individual or Groups (of Individuals)" expands the node as in the illustration below:
The Health Care Provider Taxonomy code set list is an ordered system of groups and categories indicating relationships. Naturally, a general dentist is found by clicking the term "Dental Providers" and doing so displays the following:
Note that a  indicates that there are more specific specialties and codes belonging to the term that are not visible until you click on that term. A  indicates that there are no codes below the node, while a  indicates that all codes within the node are displayed. To collapse a node that displays a minus sign, click the term. In the illustration above notice that "Dentist" has additional specialties below it and clicking the term displays those additional specialties as in the illustration below:
This is the lowest level in the list known as "Level III Area of Specialization" and "General Practice" is listed as code "1223G0001X". To verify that this code is what you will select, click the [more] link to display a definition:
Not every code will display a definition. If you wish to propose a definition, do so in writing by sending an email to: taxonomy@wpc-edi.com indicating which code you are defining along with the proposed definition.
004010X096A1, 004010X097A1, 004010X098A1, Health Care Claim: Dental, Insitutional, & Professional
In the PRV segment in the header and detail areas, specifically, PRV03.
Level I, Provider Type
A major grouping of service(s) or occupation(s) of health care providers. For example: Allopathic & Osteopathic Physicians, Dental Providers, Hospitals, etc.
Level II, Classification
A more specific service or occupation related to the Provider Type. For example, the Classification for Allopathic & Osteopathic Physicians is based upon the General Specialty Certificates as issued by the appropriate national boards. The following boards will however, have their general certificates appear as Level III areas of specialization strictly due to display limitations of the code set: Medical Genetics, Preventive Medicine, Psychiatry & Neurology, Radiology, Surgery, Otolaryngology, Pathology.
Level III, Area of Specialization
A more specialized area of the Classification in which a provider chooses to practice or make services available. For example, the Area of Specialization for provider type Allopathic & Osteopathic Physicians is based upon the Subspecialty Certificates as issued by the appropriate national boards.
The Health Care Provider Taxonomy code set Levels are organized to allow for drilling down to the provider's most specific level of specialization. The ten digit codes for each provider category are unique and contain no embedded logic. The codes and categories are to be used exactly as they are assigned in the Taxonomy list. At no time should codes be separated to form new codes. See "How do I request a change?" if you identify a need for a provider category.
The Health Care Provider Taxonomy code set is a collection of unique alphanumeric codes, ten characters in length. The Health Care Provider Taxonomy code set includes specialty categories for individuals, Groups of individuals, and non-individuals.
The “Individual Category” includes:
- Physicians
- Behavioral Health and Social Service Providers
- Chiropractic Providers
- Dental Providers
- Dietary and Nutritional Service Providers
- Emergency Medical Service Providers
- Eye and Vision Service Providers
- Nursing Service Providers
- Nursing Service Related Providers
- Other Service Providers
- Pharmacy Service Providers
- Physician Assistants and Advanced Practice Nursing Providers
- Podiatric Medicine and Surgery Providers
- Respiratory, Rehabilitative and Restorative Providers
- Speech, Language and Hearing Providers
- Student, Health Care
- Technologist, Technician, and Other Technical Service
Providers
The Group (of Individuals) category includes:
- Multi-Specialty
- Single Specialty
The Non-individual category includes:
- Agencies
- Ambulatory Health Care Facilities
- Hospital Units
- Hospitals
- Laboratories
- Managed Care Organizations
- Nursing and Custodial Care Facilities
- Residential Treatment Facilities
- Respite Care Facilities
- Suppliers
- Transportation Services
No. The Health Care Provider Taxonomy codes are self-selected by the provider. Selection of a taxonomy code does not replace any credentialing or validation process that the organization requesting the code should complete. Definitions for some of the codes do reference specialty or certifying boards as a source, but this reference in no way implies that providers have met the requirements of that board if they choose the code to identify themselves.
No. The sources for the definitions are only to cite who authored the definition. The definitions were chosen because they were identified as an overall description of the provider.
NUCC Health Care Provider Taxonomy code set Process
Effective 2001, the The National Uniform Claim Committee, NUCC  took over the administration of the Health Care Provider Taxonomy code set. Ongoing duties, including processing taxonomy code requests and maintenance of the external Health Care Provider Taxonomy code set, will fall under the NUCC Data Subcommittee. Primary distribution of the Health Care Provider Taxonomy code set remains the responsibility of Washington Publishing Company (WPC), through this web site.
MEDICAID
All requests related to Medicaid should first be coordinated by the National Medicaid EDI HIPAA (NMEH) Work Group.
The National Uniform Claim Committee, NUCC , Code Subcommittee. The NUCC Data Subcommittee also maintains the related Provider Characteristic code list.
Send an email requesting new codes or modifications to existing codes to:
taxonomy@wpc-edi.com
Criteria for reviewing change requests to the Health Care Provider Taxonomy code set is based on the following factors:
- Proven business need for acceptance / change (e.g., Cost savings, increased efficiencies, with the benefits of the acceptance / change outweighing the costs of implementation. As this is a national list, requests should help solve needs on a national level vs. state specific level.)
- No existing code that will suffice in place of the perceived need for a new code
- Does the new request (for a medical specialty code) presently exist within the American Board of Medical Specialties?
- Does the Organization code presently exist with the code list? Is there consistency between the list and the POS code list?
While existing Level I Health Care Provider Type codes and Level II Health Care Provider Classification codes have been defined, the same cannot be said for all Level III Health Care Provider Area of Specialization codes. Therefore, every new request must be accompanied by a definition. Requests lacking definitions will not be considered for inclusion in future revisions of the Health Care Provider Taxonomy code set.
The Health Care Provider Taxonomy code set is published (released) twice a year in July and January. The July publication is effective for use on October 1st and the January publication is effective for use on April 1st. The time between the publication release and the effective date is considered an implementation period to allow providers, payers and vendors an opportunity to incorporate any changes into their systems.
The current online listing is version 8.0, published January 1, 2008 and contains 5 new codes that become effective April 1, 2008.
Within the on-line listing revisions since the last release are color coded: New items are green, modified items are orange, and inactive items are red. In addition, links to a listing of new codes added on 1/1/2008 that become effective on 4/1/2008 and to all modified information posted on 1/1/2008 are below:
The complete list for the current release Version 8.0 is available as a PDF and as an electronic file suitable for updating a database.
The complete list for previous versions:
In the absence of an all-encompassing Provider Classification System, both X12N and the National Provider System Workgroup from the Centers for Medicare and Medicaid Services (CMS) commenced work on identifying and coding an external provider table that would be able to codify provider type and provider area of specialization for all medical related providers. CMS' intent was to provide a single coding structure to support work on the National Provider System, while X12N needed a single common table for trading partner use. The two projects worked independently to some extent until April 1996 when the lists were coordinated and a single taxonomy was proposed. A sub-group of the X12N TG2 WG 15 was charged with resolving differences in the two proposed taxonomies. Their work resulted in a single taxonomy that both CMS and members of X12N found meaningful, easy to use, and functional for electronic transactions.
The sub-group initially started with the CMS draft taxonomy. This list incorporated all types of providers associated with medical care in various ways. Many of the providers listed, such as technologists or technicians, support or repair equipment/machinery. A number of the providers offer medical services, in concert with others, and do not or cannot bill independently for their portion. The amount of research to validate and classify all providers using the proposed hierarchical structure was enormous. The X12N sub-group focused on medical providers who are licensed practitioners, those who bill for health-related services rendered, and those who appeared on the Medicare CMS Provider Specialty listing. This included providers who were licensed to practice medicine via state licensure agencies. In addition, a very broad definition of "areas of specialization" was used, which included nationally recognized specialties, provider self-designated specialties, areas of practice focus, and any request by any agency or trading partner submitted before the first taxonomy release. This level of detail captured specialty information in categories detailed enough to support those trading credentialing information, yet broad enough to support those wishing to trade directory level specialization information.
In 2001, ANSI ASC X12N asked the NUCC to become the official maintainer of the Health Care Provider Taxonomy code set. The NUCC has a formal operating protocol and its membership includes representation from key provider and payer organizations, as well as state and federal agencies, standard development organizations and the National Uniform Billing Committee (NUBC). Criteria for membership includes a national scope and representation of a unique constituency affected by health care electronic commerce, with an emphasis on maintaining a provider/payer balance.
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