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Health Care Provider Taxonomy Codes (HPTC) Information
HIPAA requires that covered entities comply with the requirements in the electronic transaction format implementation guides adopted as national standards. The institutional and professional claim electronic standard implementation guides (X12 837-I and 837-P) each require use of valid codes contained in the Health Care Provider Taxonomy Codes (HPTC) set when there is a need to report provider type or physician, practitioner or supplier specialty for a claim.
Valid HPTCs are those codes approved by the National Uniform Claim Committee (NUCC) for current use. The NUCC updates the code set twice a year with changes effective April 1 and October 1. Terminated codes are not approved for use after a specific date and newly approved codes are not approved for use prior to the effective date of the code set update in which each new code first appears. Although the NUCC generally posts their updates on the Washington Publishing Company (WPC) website three months prior to the effective date, changes are not effective until April 1 or October 1 as indicated in each update. Specialty and/or provider type codes issued by any entity other than the NUCC are not valid, and Medicare would be guilty of non-compliance with HIPAA if Medicare contractors accepted claims that contain invalid HPTCs.
The HPTC list is available from the WPC website in two forms. The first form is a free Adobe PDF download. The second form, which is available for purchase, is an electronic representation of the code set that facilitates automatic loading of the codes.