Definition of taxonomy codes are where to enter on a medical claim formEvery NPI number has at least 1 taxonomy code associated with it, even though it might be something you were never even aware of!!
CMS (Centers for Medicare & Medicaid Services) defines taxonomy codes as: “a hierarchical code set that consists of codes, descriptions, and definitions. Healthcare Provider Taxonomy Codes are designed to categorize the type, classification, and/or specialization of health care providers.”
Basically – it’s an additional identifying code that is “attached” to an NPI number that describes what type of health professional or entity that NPI represents. For example – all general dentists will have the same taxonomy code (although they all have their own individual NPI numbers that identify them specifically).
Here’s a few examples of taxonomy codes and what they identify:
Dentist - 122300000X
Oral Surgery (Dentist only) - 1223S0112X
Suppliers/Durable Medical Equipment & Medical Supplies - 332B00000X
Physician/General Practice - 208D00000X
Ambulance Service Provider - 341600000X
The taxonomy code set consists of two sections:
- Individuals and Groups of Individuals
The Taxonomy code set is updated twice a year, and goes into effect on April 1 and October 1.
There are tons of different taxonomy codes! Here is a link to a full list: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/TaxonomyCrosswalk.pdf
CMS describes selecting your taxonomy code or codes:
“When applying for a National Provider Identifier (NPI) from the National Plan and Provider Enumeration System (NPPES), a health care provider must select the Healthcare Provider Taxonomy Code or code description that the health care provider determines most closely describes the health care provider's type/classification/specialization, and report that code or code description in the NPI application. In some situations, a health care provider might need to report more than one Healthcare Provider Taxonomy Code or code description in order to adequately describe the type/classification/specialization. Therefore, a health care provider may select more than one Healthcare Provider Taxonomy Code or code description when applying for an NPI, but must indicate one of them as the primary.”
Sample of taxonomy code on medical claim