CODING SPECIALTY CODES

General Requirements.--Specialty codes are self-designated and describe the kind of medicine physicians, non-physician practitioners or other healthcare providers/suppliers practice. Appropriate use of specialty codes helps reduce inappropriate suspensions and improves the quality of utilization data.

A physician, non-physician practitioner or other healthcare provider or supplier will submit a specialty code change via the Form CMS-855 application. Update the specialty code that is submitted to CWF on the Part B Claim Record and the one used for prepayment and post payment medical review. This should also be consistent with your UPIN files and provider files. Follow the most cost-effective method for updating specialty codes. 

Do not add any specialty codes to the list. Send all requests for expansion of the list to your regional office (RO). Your RO will forward the list to central office (CO). CO will consider whether the requestor has the authority to bill independently; the reason or purpose for the code expansion and if a current code would suffice; the requester is/are recognized by another organization, such as the American Board of Medical Specialties; and whether the specialty treats a significant volume of the Medicare population.

All physicians that have an UPIN must have a specialty code other than 70 multispecialty "Clinic" or "Group Practice". Contact physicians who are listed as specialty 70 and obtain a valid specialty. Osteopathic codes and health care prepayment plans codes have been phased-out and been replaced with new codes.

Primary/Secondary Codes.--Physicians are allowed to choose a primary and a secondary specialty code. If your provider file can accommodate only one specialty code, then assign the code that corresponds to the greater amount of allowed charges. For example, if the practice is 50 percent ophthalmology and 50 percent otolaryngology, compare the total allowed charges for the previous year for ophthalmology and otolaryngology services. Assign the code that corresponds to the greater amount of the allowed charges.  

Physician Specialty Codes

Code Physician Specialty 

01 General Practice 

02 General Surgery 

03 Allergy/Immunology 

04 Otolaryngology 

05 Anesthesiology 

06 Cardiology 

07 Dermatology 

08 Family Practice 

09 Interventional Pain Management 

10 Gastroenterology 

11 Internal Medicine 

12 Osteopathic Manipulative Therapy 

13 Neurology 

14 Neurosurgery 

15 Unassigned 

16 Obstetrics/Gynecology 

17 Unassigned 

18 Ophthalmology 

19 Oral Surgery (dentists only) 

20 Orthopedic Surgery 

21 Unassigned 

22 Pathology 

23 Unassigned 

24 Plastic and Reconstructive Surgery 

25 Physical Medicine and Rehabilitation 

26 Psychiatry 

27 Unassigned

28 Colorectal Surgery (formerly proctology) 

29 Pulmonary Disease 

30 Diagnostic Radiology 

31 Unassigned 

33 Thoracic Surgery 

34 Urology 

35 Chiropractic 

36 Nuclear Medicine 

37 Pediatric Medicine

38 Geriatric Medicine 

39 Nephrology 

40 Hand Surgery 

41 Optometry 

44 Infectious Disease 

46 Endocrinology 

48 Podiatry 

66 Rheumatology

70 Multispecialty Clinic or Group Practice 

72 Pain Management 

76 Peripheral Vascular Disease 

77 Vascular Surgery

78 Cardiac Surgery 

79 Addiction Medicine 

81 Critical Care (Intensivists) 

82 Hematology 

83 Hematology/Oncology 

84 Preventive Medicine 

85 Maxillofacial Surgery 

86 Neuropsychiatry 

90 Medical Oncology 

91 Surgical Oncology 

92 Radiation Oncology

93 Emergency Medicine 

94 Interventional Radiology 

98 Gynecological/Oncology 

99 Unknown Physician Specialty