NATIONAL PRACTITIONER DATA BANK (NPDB)
CODE LISTS
Version 2.10
December 2022
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Health Workforce
Division of Practitioner Data Bank
Parklawn Building, Room 11SWH03
5600 Fishers Lane
Rockville, Maryland 20857
Code Lists Version 2.10
December 2022 i
Document Change History
The table below identifies changes that have been incorporated into each baseline of this document.
Table 1 - Document Change History
Date Version # Change Description
4/2009 1.00 Initial Version.
New codes go into effect June 15, 2009. The following code lists have been
updated:
AAR Adverse Action Classification Codes - Individual Subjects.
• Clinical Privileges - Actions: Added codes 1615, 1637, 1638, 1642, 1643, 1644,
1655, 1656.
• Clinical Privileges - Revisions to Actions: Added codes 1610, 1615, 1630, 1632,
1637, 1638, 1639, 1640, 1642, 1643, 1644, 1645, 1655, 1656, 1682, 1696.
• Exclusion or Debarment - Revisions to Actions: Added code 1514.
• Federal Licensure - Revisions to Actions: Added codes 1110, 1125, 1135, 1140,
1147, 1179, 1189, 1199, 1283, 1297.
• Government Administrative - Actions: Added code 1525.
• Government Administrative - Revisions to Actions: Added codes 1510, 1512,
1517, 1520, 1530, 1532, 1550, 1551, 1555, 1560, 1562, 1565, 1589, 1597.
• Health Plan - Actions: Added codes 1931, 1951, 1952; Retired code 1950.
• Health Plan - Revisions to Actions: Added codes 1920, 1930, 1931, 1932, 1941,
1942, 1989, 1997.
• Professional Society - Actions: Added code 1735.
• Professional Society - Revisions to Actions: Added codes 1710, 1730, 1735,
1745, 1796.
• State Licensure - Revisions to Actions: Added codes 1110, 1125, 1135, 1138,
1139, 1140, 1147, 1173, 1189, 1199, 1283, 1297.
• State Licensure - Revisions to Nurse Multi-State Privilege Actions: Added
codes 1310, 1325, 1335, 1340, 1347, 1373, 1389, 1399, 1483, 1497.
AAR Adverse Action Classification Codes - Organization Subjects.
• Exclusion or Debarment - Revisions to Actions: Added code 3519.
• Federal or State Licensure - Actions: Added codes 3138, 3204, 3205, 3206,
3207, 3210, 3212, 3220, 3225, 3230, 3233, 3239; Change description on code
3143.
• Federal or State Licensure - Revisions to Actions: Added codes 3111, 3136,
3138, 3141, 3143, 3202, 3203, 3204, 3205, 3206, 3207, 3210, 3212, 3220, 3225,
3230, 3233, 3239, 3284, 3297.
• Government Administrative - Actions: Added code 3525.
• Government Administrative - Revisions to Actions: Added codes 3202, 3203,
3205, 3206, 3207, 3210, 3212, 3230, 3232, 3510, 3512, 3517, 3520, 3540, 3542,
3551, 3589, 3597.
• Health Plan - Actions: Added codes 3591, 3592; Retired code 3950.
• Health Plan - Revisions to Actions: Added codes 3920, 3930, 3932, 3989, 3997.
Code Lists Version 2.10
December 2022 ii
Date Version # Change Description
4/2009 1.00
AAR Adverse Action Classification Codes - Retired.
● Codes 1950 and 3950 were retired.
AAR Basis for Action Codes - Individual Subjects
• Clinical Privileges Actions: Added codes 17, 18, 24, 25, 50, 70, 79, AH, D4,
D5, D6, D7, D8, E6; Retired code 10.
• Exclusion or Debarment Actions: Added codes 50, 84.
• Federal or State Licensure Actions: Added codes 17, 18, 23, 24, 25, 35, 36, 37,
50, 84, D4, D5, D6, D7, D8, E6; Retired code 10.
• Government Administrative Actions: Added codes 17, 18, 24, 25, 50, 52, 84,
D4, D5, D6, D7, D8, E6; Retired code 10.
• Health Plan Actions: Added codes 17, 18, 24, 25, 50, D4, D5, D6, D7, D8, E6;
Change description on code A9; Retired code 10.
• Professional Society Actions: Added codes 17, 18, 24, 25, 50, 70, 79, AH, D4,
D5, D6, D7, D8, E6; Retired code 10.
AAR Basis for Action Codes - Organization Subjects.
• Exclusion or Debarment Actions: Added codes 50, 84.
• Federal or State Licensure Actions: Added codes 17, 18, 50, 57, 84, A5, AE,
AF, AG, E6, G1, G2, H7, H8, H9.
• Government Administrative Actions: Added codes 17, 18, 50, 52, 84, E6.
• Health Plan Actions: Added codes 17, 18, 50, 84, E6.
AAR Basis for Action Codes - Retired.
● Code 10, Unprofessional Conduct was retired.
Occupation/Field of Licensure Codes.
● Added codes 502, 503, 504, 540, 607, 759; Changed description on code 501,
758.
8/2009 1.01 New changes go into effect August 31, 2009. The following code lists have been
updated:
Error Codes.
● Code RQ was added.
Void Reason Codes.
● Table was added.
8/2009 1.02 New changes go into effect August 31, 2009. The following code list has been
updated:
Error Codes.
● Changed description for code PD.
Code Lists Version 2.10
December 2022 iii
Date Version # Change Description
TBD 1.03 Below is a summary of changes to the Code Lists version 1.03. This version
contains changes that are based on the anticipated final regulations to implement
Section 1921 of the Social Security Act, as amended by section 5(b) of the Medicare
and Medicaid Patient and Program Protection Act of 1987 (MMPPPA), and as
amended by the Omnibus Budget Reconciliation Act of 1990. There may be
additional changes to this document as a result of final federal review process.
This version will be effective on the date as published in the Federal Register. This
Code Lists version 1.03 will replace version 1.02. The changes in this draft version
are indicated below:
The following code lists have been updated:
Adverse Action Classification Codes - Individual Subjects.
● Federal and State Licensure Actions: modified descriptions for codes 1149 and
1189.
● State Licensure Actions: added codes 1338 and 1339.
Adverse Action Classification Codes - Organization Subjects.
● State Licensure Actions: added code 3238.
● Accreditation Actions: added codes 3850, 3855, 3859, 3864, 3860, and 3862.
B
asis for Action Codes - Organization Subjects.
● Accreditation Actions: added codes 91 and 92.
Error Codes.
● Added codes AM, CC, CD, CE, CF, Q1, Q4, Q5, Q6, Q7, Q8, Q9, QA, QB, QC,
QD, QE, QF.
AAR
Type of Negative Finding Codes.
● Added list of negative finding codes for Peer Review Organization reports.
AAR
Basis for Finding Codes.
● Added list of basis for finding codes for Peer Review Organization reports.
AAR
Type of Action Codes.
● Added descriptions for codes 7, Peer Review Organization and 8, Accreditation.
Code Lists Version 2.10
December 2022 iv
Date Version # Change Description
1/2010 1.04 New changes go into effect January 25, 2010. The following code lists have been
updated:
Error Codes.
● Code RM was added.
AAR Basis for Action Codes - Individual Subjects.
● Government Administrative Actions: added code 21.
AAR Basis for Action Codes - Organization Subjects.
● Government Administrative Actions: added code 21.
AAR Basis for Action Codes - Retired.
● Code 52 was retired.
3/1/2010 1.05 Below is a summary of changes to the Code Lists version 1.05. This version
contains changes that are based on the final rule for Section 1921 of the Social
Security Act, as amended by section 5(b) of the Medicare and Medicaid Patient and
Program Protection Act of 1987 (MMPPPA), and as amended by the Omnibus
Budget Reconciliation Act of 1990. The final rule was published in the Federal
Register January 28, 2010. Effective March 1, 2010, the Data Banks accepts reports
and queries to the NPDB under Section 1921.
This version will be effective on March 1, 2010. This Code Lists version 1.05 will
replace version 1.04. The changes in this version are indicated below:
● Announcement of final rule.
Basis for Action Codes - Organization Subjects.
● Accreditation Actions: added code 92 and removed code 91.
AAR Type of Negative Finding Codes.
● Added code 1841 for Revision to Action Reports.
4/12/2010 1.06 This Code Lists version 1.06 will replace version 1.05. The change in this version is
indicated below:
AAR Type of Action Codes
● Expanded the description for code 1(SL) to include Section 1921 actions.
Code Lists Version 2.10
December 2022 v
Date Version # Change Description
6/14/2010 1.07 This Code Lists version 1.07 will replace version 1.06. The changes in this version
are indicated below:
Error Codes.
● Added code J7.
● Changed description for code B5.
8/30/2010 1.08 This Code Lists version 1.08 will replace version 1.07. The changes in this version
are indicated below:
QRXS Client Program Status Codes.
● Added codes C61, C62.
● Changed description for code C64.
QR
XS Web Service Status Codes.
Added new code list.
Code Lists Version 2.10
December 2022 vi
Date Version # Change Description
11/8/2010 1.09 This Code Lists version 1.09 will replace version 1.08. Formatting changes were
made throughout the document. The following code lists have been updated:
Error Codes.
● Added code MY.
● Updated the URLs in codes RE, RF, and RG.
QRXS Client Program Status Codes and QRXS Web Service Status Codes
● Updated the URLs in codes C16 and C17 and in the table footer notes.
Occupation/Field of Licensure Codes.
● Added codes 134, 550.
1/24/2011 1.10 This Code Lists version 1.10 will replace version 1.09. The changes in this version
are indicated below:
ITP Client Program Status Codes
● Updated the description for code C25.
QRXS Client Program Status Codes
● Updated the description for code C02.
4/4/2011 1.11 This Code Lists version 1.11 will replace version 1.10. The changes in this version
are indicated below:
AAR Adverse Action Classification Codes - Organization Subjects.
● Federal or State Licensure Actions - modified the description for code 3238.
E
rror Codes.
● Added code IC.
Code Lists Version 2.10
December 2022 vii
Date Version # Change Description
6/6/2011 1.12 This Code Lists version 1.12 will replace version 1.11. The changes in this version
are indicated below:
AAR Basis for Action Codes - Individual Subjects.
● Federal or State Licensure Actions - added code I1.
AAR
Basis for Action Codes - Organization Subjects.
● Federal or State Licensure Actions - added code I1.
E
rror Codes.
● Added codes MZ, SM, SN, SO, UA, UF, UJ, UM, UN, UP, US, and UZ.
● Modified existing codes S3, S4, and S8.
8/22/2011 1.13 This Code Lists version 1.13 will replace version 1.12. The changes in this version
are indicated below:
AAR Adverse Action Codes - Individual Subjects.
● State Licensure Actions - added code 1150.
Error Codes.
● Modified existing code AA.
Changed PDS references to Continuous Query throughout entire document.
11/7/2011 1.14 This Code Lists version 1.14 will replace version 1.13. The changes in this version
are indicated below:
Error Codes.
● Modified existing codes 54 and 56.
1/24/2012 1.15 This Code Lists version 1.15 will replace version 1.14. The changes in this version
are indicated below:
Error Codes.
● Modified existing code AA.
Code Lists Version 2.10
December 2022 viii
Date Version # Change Description
4/2/2012 1.16 This Code Lists version 1.16 will replace version 1.15. The changes in this version
are indicated below:
Error Codes.
● Added ITP client program status codes C68, C69.
● Added QRXS client program status codes C68, C69.
● Added QRXS Web Service status codes C68, C69.
8/27/2012 1.17 This Code Lists version 1.17 will replace version 1.16. The changes in this version
are indicated below:
Statutory Authority Codes
● Inserted Tables 191 and 192, Statutory Authority QRXS Codes and Statutory
Authority ITP Codes, respectively.
10/10/201
2
2.00
This Code Lists version 2.00 will replace version 1.17. The changes in this version
are indicated below:
Error Codes.
● Added code RR.
Code Lists Version 2.10
December 2022 ix
Date Version # Change Description
3/2013 2.01 This version contains changes that are based on the final rule for merging the NPDB
and HIPDB into one Data Bank, which was published in the Federal Register April
5, 2013. This Code Lists version 2.01 will be effective on May 6, 2013, and will
replace version 2.00. The changes in this version are indicated below:
AAR Adverse Action Codes – Individual Subjects
● Government Administrative – Initial and Revision tables split table between
“Actions Related to Certification Agreements or Contracts for Participation in a
Federal or State Health Care Program” and “Other Adjudicated Actions or
Decisions by a Federal or State Agency”
o Initial Government Administrative Action Classification Codes
Retired Codes: 1520, 1530, 1532
● Added Codes: 1521, 1531, 1533, 1536, 1539, 1556, 1579, 1588
o Revision Government Administrative Action Classification Codes
● Added Codes: 1536, 1539, 1556, 1579, 1588, 1599
● The following code numbers were split and given new codes:
1590, 1592, 1595, 1596, 1597
o New codes for “Actions Related to Certification
Agreements or Contracts for Participation in a Federal
or State Health Care Program”, respectively: 1580,
1581, 1582, 1583, 1584
o New codes for “Other Adjudicated Actions or Decisions
by a Federal or State Agency”, respectively: 1590, 1591,
1592, 1593, 1594
AAR Adverse Action Codes – Organization Subjects
● Government Administrative – Initial and Revision tables split between “Actions
Related to Certification Agreements or Contracts for Participation in a Federal or
State Health Care Program” and “Other Adjudicated Actions or Decisions by a
Federal or State Agency”
o Initial Government Administrative Action Classification Codes
● Retired Codes: 3230, 3520
● Added Codes: 3521, 3531, 3538, 3539, 3579, 3588, 3599
o Revision Government Administrative Action Classification Codes
● Retired Codes: 3230, 3520
● Added Codes: 3231, 3521, 3538, 3539, 3579, 3588, 3599
● The following code numbers were split and given new codes:
3590, 3592, 3595, 3596, 3597
o New codes for “Actions Related to Certification
Agreements or Contracts for Participation in a Federal
or State Health Care Program”, respectively: 3580,
3581, 3582, 3583, 3584
o New codes for “Other Adjudicated Actions or Decisions
by a Federal or State Agency”, respectively: 3590, 3591,
3592, 3593, 3594
Code Lists Version 2.10
December 2022 x
Date Version # Change Description
4/2013 2.02 This version contains changes that are based on the final rule for merging the NPDB
and HIPDB into one Data Bank, which was published in the Federal Register April
5, 2013. This Code Lists version 2.02 will be effective on May 6, 2013, and will
replace version 2.01. The changes in this version are indicated below:
AAR Adverse Action Codes – Individual Subjects
● Government Administrative –
Retired Codes: 1550, 1560, 1562, 1565, 1589
o Initial Government Administrative Action Classification Codes
● Actions Related to Certification Agreements or Contracts for
Participation in a Federal or State Health Care Program
o Removed code 1588, 1589
o Added code 1599, 1598
● Other Adjudicated Actions or Decisions by a Federal or State
Agency
o Removed code 1550, 1560, 1562, 1565, 1599
o Added code 1552, 1561, 1563, 1566, 1588
o Revision Government Administrative Action Classification Codes
● Actions Related to Certification Agreements or Contracts for
Participation in a Federal or State Health Care Program
o Removed codes 1580, 1581, 1582, 1583, 1584, 1588,
1589
o Added codes 1590, 1592, 1595, 1596, 1597, 1598, 1599
● Ot
her Adjudicated Actions or Decisions by a Federal or State
Agency
o Removed code 1550, 1560, 1562, 1565, 1590, 1591,
1592, 1593, 1594, 1599
o Added codes 1552, 1561, 1563, 1566, 1580, 1581, 1582,
1583, 1584, 1588
AAR Adverse Action Codes – Organization Subjects
● Government Administrative –
Retired Codes: 3232, 3589
o Initial Government Administrative Action Classification Codes
● Actions Related to Certification Agreements or Contracts for
Participation in a Federal or State Health Care Program
o Removed code 3232, 3588, 3589
o Added code 3234, 3598, 3599
● Other Adjudicated Actions or Decisions by a Federal or State
Agency
o Removed code 3599
o Added code 3588
Code Lists Version 2.10
December 2022 xi
Date Version # Change Description
4/2013 2.02 o Revision Government Administrative Action Classification Codes
● Actions Related to Certification Agreements or Contracts for
Participation in a Federal or State Health Care Program
o Removed codes 3232, 3580, 3581, 3582, 3583, 3584,
3588, 3589
o Added codes 3234, 3590, 3592, 3595, 3596, 3597, 3598,
3599
● Other Adjudicated Actions or Decisions by a Federal or State
Agency
o Removed code 3590, 3591, 3592, 3593, 3594, 3599
Added codes 3580, 3581, 3582, 3583, 3584, 3588
7/2014 2.03 This Code Lists version 2.03 will replace version 2.02. The changes in this version
are indicated below:
● Removed Table 196 – Statutory Authority ITP Codes
● Removed Table 198 - ITP Client Program Status Codes
● Removed codes 01,87, 88, 89, 90, 91, B7, C3, RM, and SI from the Error Codes
table.
● Modified Table 142, Code A.
Code Lists Version 2.10
December 2022 xii
Date Version # Change Description
11/17/2014
2.04 This Code Lists version 2.04 will replace version 2.03. The changes in this version
are indicated below:
AAR Adverse Action Codes – Individual Subjects:
● Tables 16 and 17:
o Added codes 1151, 1179
● Table 18:
o Removed codes 1348, 1349
● Table 19:
o Added codes 1338, 1339
E
rror Codes Table 196:
● Added codes PN and H4
Occupation/Field of Licensure Codes, Tables 150-170:
● Retired and replaced the following codes:
o Retired code 134 and replaced with existing code 130
o Retired code 148 and replaced with existing code 150
o Retired code 654 and replaced with existing code 660
o Retired code 657 and replaced with existing code 661
o Retired code 402 and replaced with new codes 662, 664, 665, 667
o Retired code 260 and replaced with existing code 270
o Retired code 060 and replaced with existing code 050
o Retired code 645 and replaced with existing code 642
o Retired code 502 and replaced with existing code 501
o Retired code 504 and replaced with existing code 503
o Retired code 540 and replaced with existing code 530
o Retired code 550 and replaced with existing code 530
o Retired code 752 and replaced with existing code 758
o Retired code 755 and replaced with existing code 758
o Retired code 759 and replaced with existing code 758
o Retired code 812 and replaced with existing code 810
● Updated the description of codes 015, 025, 100, 150, 660, 270, 642, 501, 503,
530, 758, 810
● Updated the title of Table 155
● Added new codes 142, 176, 613, 604, 605, 652, 653, 662, 664, 665, 667,
668, 211, 281, 637, 076, 649, 374, 658, 471, 551
Code Lists Version 2.10
December 2022 xiii
Date Version # Change Description
10/2016 2.05 This Code Lists version 2.05 will replace version 2.04. The changes in this version
are indicated below:
• Tables 16, 17
o Added code 1179
• Tables 19,20
o Added code 1351
• Tables 149, 194:
o Added code RQ
• Updated the URL to https://www.npdb.hrsa.gov
6/30/2018 2.06 This Code Lists version 2.06 will replace version 2.05. The changes in this version
are indicated below:
● Added Dispute Status Codes – See Table 206
o Added a new value for Dispute Status – Q – Reconsideration Requested.
The rest of the codes in this table are unchanged.
● Added Error Codes MI and IP for new MMPR field (Total Number of
Claimants Included in Settlement) – See Table 198.
● Added the following tables to list existing codes. These codes have not
changed in this version. The codes will be maintained here instead of in the
XML schema definition (XSD) files:
o Added AAR Automatic Reinstatement Codes – See Table 119.
o Added JOCR Jurisdiction Codes – See Table 124.
o Added AAR Type of Action Codes (Old Format) – See Table 118.
o Added MMPR Report Type Codes – See Table 136.
o Added MMPR Relationship of Entity Codes – See Table 146.
o Added MMPR Relationship of Entity Codes (Old Format) – See
Table 147.
o Added MMPR Payment Result Of Codes – See Table 148.
o Added MMPR Payment Result Of Codes (Old Format) – See Table
149.
o Added MMPR Payment Type Codes – See Table 150.
o Added MMPR Patient Type Codes – See Table 151.
o Added Gender Codes – See Table 205.
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December 2022 xiv
Date Version # Change Description
4/5/2019
2.07 This Code Lists version 2.07 will replace version 2.06. The changes in this version
are indicated below:
● Converted Nursing Multi-State Licensure Adverse Action Classification
Codes (AACCs) to generic Multi-State Licensure AACCs – See Tables 18
and 19, and accompanying Footnote 3.
● Removed “(NPDB Only)” text from Adverse Action Classification Codes
1138, 1139, 1150, 1338 and 1339 - See Tables 16, 17, and 18.
● Clarified footnotes 1 and 2 for State Licensure Adverse Action Classification
Codes (Tables 16-19).
● Added new Adverse Action Classification Code 1155 (“Withdrawal of
Renewal Application While Under Investigation”) to the Federal and State
Licensure action codes – See Tables 6, 7, 16, and 17.
● Emergency Medical Technician (EMT) Field of Licensure (FOL) Code
Changes:
o Updated descriptions of the existing EMT FOL codes.
o Added FOL code 240 – Emergency Medical Responder.
o See Table 167.
● Added MMPR Payment Result Of Code “O” (“Other”) – See Table 148.
● Error Codes changes:
o Updated Error Code “38” to apply to both missing and invalid
“payment result of” MMPR data.
o Added Error Code “N0” to indicate when Payment Result of
Description should be provided or when it should not be provided.
o Updated description of Error Code “AI” to refer to more generic
Multi-State licensure.
o Added new Error Codes “AN” and “AO” to reflect new restrictions
on the automatic reinstatement field.
o Added AH error code for the restriction on multiple adverse action
classification codes for multi-state license actions
o See Table 208.
6/24/2021
2.08 This Code Lists version 2.08 will replace version 2.07. The changes in this version
are indicated below:
• Updated all void reason descriptions – See Table 153
• Updated "State Licensure" report type to be "State Licensure or
Certification"
• Error Codes changes:
o Added "RS” error code for missing or invalid void reason
description
o Added "RP" error code for State Licensure and Certification reports
whose primary field of licensure is not in the board's regulated
professions list
o See Table 208
• Updated the description for Adverse Action Classification Code 1179, see
Tables 16 and 17
• Updated the descriptions for AAR Basis for Action Codes H2, H3, H4, H5,
H6, see Tables 44, 55, 64, 73, 82, 95, 103, 111
Code Lists Version 2.10
December 2022 xv
Date Version # Change Description
8/20/2021
2.09 This Code Lists version 2.09 will replace version 2.08. The changes in this version
are indicated below:
• Updated S2 error code description to match updated password length
requirements
12/16/2022
2.10 This Code Lists version 2.10 will replace version 2.09. The changes in this version
are indicated below:
The following code lists have been updated:
AAR Basis for Action Codes – Retired
• Codes 05, 11, 12, 15, 25, 45, 53, 84, A3, D6, D8, F7, and F5 were retired, see
Table 113.
AAR Basis for Action Codes
• Added codes FE, FF, and FG. Updated the descriptions for codes 31, 37, 39, 50,
55, A1, D2, D7, F1, F2, F3, F4, F6, and H1. See Tables 37-111.
• Added guidelines and examples for Federal and State Licensure codes, see
Tables 48-56.
• Updated the description for AAR Basis for Finding Code 55, see Table 114.
AAR Adverse Action Classification Codes
• Updated the description for code 1155, see Tables 6, 7, 16, 17.
• Updated the description for code 1655, see Tables 2, 3.
Updated the following codes to reference “NPDB Correspondence” instead of “Data
Bank Correspondence”:
• Transaction Code DB, see Table 155.
• Error Code RE, see Table 208.
• QRXS Client Program Status Code C16, see Table 209.
• QRXS Web Service Status Code C16, see Table 210.
Code Lists Version 2.10
December 2022 xvii
Table of Contents
Table 1 - Document Change History ......................................................................................................................................................... i
AAR Adverse Action Classification Codes - Individual Subjects ............................................................................... 1
Clinical Privileges Actions ...................................................................................................................................... 1
Table 2 - Clinical Privileges - Actions ..................................................................................................................................................... 1
Table 3 - Clinical Privileges - Revisions to Actions (No Basis for Action Codes Required) ................................................................... 1
Exclusion or Debarment Actions ............................................................................................................................ 2
Table 4 - Exclusion or Debarment - Actions ............................................................................................................................................ 2
Table 5 - Exclusion or Debarment - Revisions to Actions (No Basis for Action Codes Required) ......................................................... 2
Federal Licensure Actions ..................................................................................................................................... 3
Table 6 - Licensure - Actions ................................................................................................................................................................... 3
Table 7 - Licensure - Revisions to Actions (No Basis for Action Codes Required) ................................................................................ 3
Government Administrative Actions ....................................................................................................................... 4
Table 8 - Government Administrative - Actions Related to Certification Agreements or Contracts for Participation in a Federal or
State Health Care Program ....................................................................................................................................................................... 4
Table 9 - Government Administrative - Other Adjudicated Actions or Decisions by a Federal or State Agency .................................... 4
Table 10 - Government Administrative - Revisions to Actions (No Basis for Action Code Required) - Actions Related to Certification
Agreements or Contracts for Participation in a Federal or State Health Care Program ............................................................................ 4
Table 11 - Government Administrative - Revisions to Actions (No Basis for Action Code Required) - Other Adjudicated Actions or
Decisions by a Federal or State Agency ................................................................................................................................................... 5
Health Plan Actions ................................................................................................................................................ 6
Table 12 - Health Plan Action - Actions .................................................................................................................................................. 6
Table 13 - Health Plan Action - Revisions to Actions (No Basis for Action Code Required) ................................................................. 6
Professional Society Actions .................................................................................................................................. 6
Table 14 - Professional Society - Actions ................................................................................................................................................ 6
Table 15 - Professional Society - Revisions to Actions (No Basis for Action Code Required) ............................................................... 6
State Licensure or Certification Actions ................................................................................................................. 7
Table 16 - Licensure - Actions ................................................................................................................................................................. 7
Table 17 - Licensure - Revisions to Actions (No Basis for Action Codes Required)............................................................................... 7
Table 18 - Licensure - Multi-State Privilege Actions
3
............................................................................................................................. 8
Table 19 - Licensure - Revisions to Multi-State Privilege Actions (No Basis for Action Codes Required)
3
........................................... 8
AAR Adverse Action Classification Codes (Old Format) ........................................................................................... 9
Table 20 - AAR Adverse Action Classification Codes (Old Format) ...................................................................................................... 9
Table 21 - AAR Adverse Action Classification Codes - Old Format (continued) ................................................................................. 10
AAR Adverse Action Classification Codes - Organization Subjects ........................................................................ 11
Accreditation Actions ........................................................................................................................................... 11
Table 22 - Accreditation Actions ........................................................................................................................................................... 11
Table 23 - Accreditation Revisions to Actions (No Basis for Action Codes Required) ......................................................................... 11
Exclusion or Debarment Actions .......................................................................................................................... 11
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December 2022 xviii
Table 24 - Exclusion or Debarment Actions .......................................................................................................................................... 11
Table 25 - Exclusion or Debarment Revisions to Actions (No Basis for Action Code Required) ......................................................... 11
Federal Licensure, State Licensure or Certifications Actions .............................................................................. 12
Table 26 - Licensure Actions ................................................................................................................................................................. 12
Table 27 - Licensure Revisions to Actions (No Basis for Action Codes Required) ............................................................................... 12
Government Administrative Actions ..................................................................................................................... 13
Table 28 - Government Administrative Actions - Actions Related to Certification Agreements or Contracts for Participation in a
Federal or State Health Care Program .................................................................................................................................................... 13
Table 29 - Government Administrative - Other Adjudicated Actions or Decisions by a Federal or State Agency ................................ 13
Table 30 - Government Administrative - Revisions to Actions (No Basis for Action Code Required) - Actions Related to Certification
Agreements or Contracts for Participation in a Federal or State Health Care Program .......................................................................... 13
Table 31 - Government Administrative - Revisions to Actions (No Basis for Action Code Required) - Other Adjudicated Actions or
Decisions by a Federal or State Agency ................................................................................................................................................. 14
Health Plan Actions .............................................................................................................................................. 15
Table 32 - Health Plan Action - Actions ................................................................................................................................................ 15
Table 33 - Health Plan Action - Revisions to Actions (No Basis for Action Code Required) ............................................................... 15
AAR Adverse Action Classification Codes - Retired ............................................................................................... 16
Table 34 - AAR Adverse Action Classification Codes - Retired ........................................................................................................... 16
AAR Type of Negative Finding Codes - Individual Subjects ................................................................................... 17
Peer Review Organization ................................................................................................................................... 17
Table 35 - Initial Actions ....................................................................................................................................................................... 17
Table 36 - Revision to Actions .............................................................................................................................................................. 17
AAR Basis for Action Codes - Individual Subjects .................................................................................................. 18
Clinical Privileges Actions .................................................................................................................................... 18
Table 37 - Non-Compliance With Requirements ................................................................................................................................... 18
Table 38 - Criminal Conviction or Adjudication ................................................................................................................................... 18
Table 39 - Confidentiality, Consent or Disclosure Violations ............................................................................................................... 18
Table 40 - Misconduct or Abuse ............................................................................................................................................................ 18
Table 41 - Fraud, Deception, or Misrepresentation ................................................................................................................................ 19
Table 42 - Unsafe Practice or Substandard Care .................................................................................................................................... 19
Table 43 - Improper Supervision or Allowing Unlicensed Practice ....................................................................................................... 19
Table 44 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation .................................................................... 19
Table 45 - Other ..................................................................................................................................................................................... 19
Exclusion or Debarment Actions .......................................................................................................................... 20
Table 46 - Criminal Conviction ............................................................................................................................................................. 20
Table 47 - Other ..................................................................................................................................................................................... 20
Federal Licensure, State Licensure or Certifications Actions .............................................................................. 21
Table 48 - Non-Compliance With Requirements ................................................................................................................................... 21
Table 49 - Criminal Conviction or Adjudication ................................................................................................................................... 22
Table 50 - Confidentiality, Consent or Disclosure Violations ............................................................................................................... 23
Table 51 - Misconduct or Abuse ............................................................................................................................................................ 23
Table 52 - Fraud, Deception, or Misrepresentation ................................................................................................................................ 25
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Table 53 - Unsafe Practice or Substandard Care .................................................................................................................................... 26
Table 54 - Improper Supervision or Allowing Unlicensed Practice ....................................................................................................... 27
Table 55 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation .................................................................... 27
Table 56 - Other ..................................................................................................................................................................................... 28
Government Administrative Actions ..................................................................................................................... 28
Table 57 - Non-Compliance With Requirements ................................................................................................................................... 28
Table 58 - Criminal Conviction or Adjudication ................................................................................................................................... 28
Table 59 - Confidentiality, Consent or Disclosure Violations ............................................................................................................... 28
Table 60 - Misconduct or Abuse ............................................................................................................................................................ 28
Table 61 - Fraud, Deception, or Misrepresentation ................................................................................................................................ 30
Table 62 - Unsafe Practice or Substandard Care .................................................................................................................................... 30
Table 63 - Improper Supervision or Allowing Unlicensed Practice ....................................................................................................... 30
Table 64 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation .................................................................... 30
Table 65 - Other ..................................................................................................................................................................................... 30
Health Plan Actions .............................................................................................................................................. 31
Table 66 - Non-Compliance With Requirements ................................................................................................................................... 31
Table 67 - Criminal Conviction or Adjudication ................................................................................................................................... 31
Table 68 - Confidentiality, Consent or Disclosure Violations ............................................................................................................... 31
Table 69 - Misconduct or Abuse ............................................................................................................................................................ 31
Table 70 - Fraud, Deception, or Misrepresentation ................................................................................................................................ 32
Table 71 - Unsafe Practice or Substandard Care .................................................................................................................................... 32
Table 72 - Improper Supervision or Allowing Unlicensed Practice ....................................................................................................... 32
Table 73 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation .................................................................... 32
Table 74 - Other ..................................................................................................................................................................................... 32
Professional Society Actions ................................................................................................................................ 33
Table 75 - Non-Compliance With Requirements ................................................................................................................................... 33
Table 76 - Criminal Conviction or Adjudication ................................................................................................................................... 33
Table 77 - Confidentiality, Consent or Disclosure Violations ............................................................................................................... 33
Table 78 - Misconduct or Abuse ............................................................................................................................................................ 33
Table 79 - Fraud, Deception, or Misrepresentation ................................................................................................................................ 33
Table 80 - Unsafe Practice or Substandard Care .................................................................................................................................... 34
Table 81 - Improper Supervision or Allowing Unlicensed Practice ....................................................................................................... 34
Table 82 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation .................................................................... 34
Table 83 - Other ..................................................................................................................................................................................... 34
AAR Basis for Action Codes - Organization Subjects ............................................................................................. 35
Accreditation Actions ........................................................................................................................................... 35
Table 84 - Non-Compliance With Federal, State or Contractual Requirements..................................................................................... 35
Table 85 - Other ..................................................................................................................................................................................... 35
Exclusion or Debarment Actions .......................................................................................................................... 35
Table 86 - Criminal Conviction ............................................................................................................................................................. 35
Table 87 - Other ..................................................................................................................................................................................... 35
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Federal Licensure, State Licensure or Certifications Actions .............................................................................. 36
Table 88 - Non-Compliance With Requirements ................................................................................................................................... 36
Table 89 - Criminal Conviction or Adjudication ................................................................................................................................... 36
Table 90 - Confidentiality, Consent or Disclosure Violations ............................................................................................................... 36
Table 91 - Conflict of Interest ................................................................................................................................................................ 36
Table 92 - Fraud, Deception, or Misrepresentation ................................................................................................................................ 37
Table 93 - Substandard Care or Patient Neglect/Abuse ......................................................................................................................... 37
Table 94 - Improper Supervision or Allowing Unlicensed Practice ....................................................................................................... 37
Table 95 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation .................................................................... 37
Table 96 - Other ..................................................................................................................................................................................... 37
Government Administrative Actions ..................................................................................................................... 38
Table 97 - Non-Compliance With Requirements ................................................................................................................................... 38
Table 98 - Criminal Conviction or Adjudication ................................................................................................................................... 38
Table 99 - Confidentiality, Consent or Disclosure Violations ............................................................................................................... 38
Table 100 - Conflict of Interest .............................................................................................................................................................. 38
Table 101 - Fraud, Deception, or Misrepresentation .............................................................................................................................. 38
Table 102 - Substandard Care or Patient Neglect/Abuse ....................................................................................................................... 39
Table 103 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation .................................................................. 39
Table 104 - Other ................................................................................................................................................................................... 39
Health Plan Actions .............................................................................................................................................. 40
Table 105 - Non-Compliance With Requirements ................................................................................................................................. 40
Table 106 - Criminal Conviction or Adjudication ................................................................................................................................. 40
Table 107 - Confidentiality, Consent or Disclosure Violations.............................................................................................................. 40
Table 108 - Conflict of Interest .............................................................................................................................................................. 40
Table 109 - Fraud, Deception or Misrepresentation ............................................................................................................................... 40
Table 110 - Substandard Care or Patient Neglect/Abuse ....................................................................................................................... 41
Table 111 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation .................................................................. 41
Table 112 - Other ................................................................................................................................................................................... 41
AAR Basis for Action Codes - Retired ..................................................................................................................... 42
Table 113 - AAR Basis for Action Codes - Retired ............................................................................................................................... 42
AAR Basis for Finding Codes - Individual Subjects ................................................................................................. 43
Peer Review Organization ................................................................................................................................... 43
Table 114 - Fraud, Deception or Misrepresentation ............................................................................................................................... 43
Table 115 - Unsafe Practice or Substandard Care .................................................................................................................................. 43
Table 116 - Other ................................................................................................................................................................................... 43
AAR Type of Action Codes ...................................................................................................................................... 44
Table 117 - AAR Type of Action Codes ................................................................................................................................................ 44
AAR Type of Action Codes (Old Format) ................................................................................................................ 45
Table 118 - AAR Type of Action Codes (Old Format) .......................................................................................................................... 45
AAR Automatic Reinstatement Codes..................................................................................................................... 46
Table 119 - AAR Automatic Reinstatement Codes ............................................................................................................................... 46
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Nature of Relationship Codes .................................................................................................................................. 47
Individual Subjects ............................................................................................................................................... 47
Table 120 - Individual Subjects ............................................................................................................................................................. 47
Organization Subjects .......................................................................................................................................... 47
Table 121 - Organization Subjects ......................................................................................................................................................... 47
JOCR Act or Omission Codes ................................................................................................................................. 48
Table 122 - JOCR Act or Omission Codes ............................................................................................................................................ 48
JOCR Type of Action Codes ................................................................................................................................... 49
Table 123 - JOCR Type of Action Codes .............................................................................................................................................. 49
JOCR Jurisdiction Codes ........................................................................................................................................ 49
Table 124 - JOCR Jurisdiction Codes .................................................................................................................................................... 49
MMPR Act or Omission Codes (Old Format MMPR) .............................................................................................. 50
Table 125 - Diagnosis ............................................................................................................................................................................ 50
Table 126 - Anesthesia ........................................................................................................................................................................... 50
Table 127 - Surgery ............................................................................................................................................................................... 50
Table 128 - Medication .......................................................................................................................................................................... 50
Table 129 - Intravenous and Blood Products ......................................................................................................................................... 50
Table 130 - Obstetrics ............................................................................................................................................................................ 50
Table 131 - Treatment ............................................................................................................................................................................ 50
Table 132 - Monitoring .......................................................................................................................................................................... 50
Table 133 - Biomedical Equipment/Product .......................................................................................................................................... 51
Table 134 - Miscellaneous ..................................................................................................................................................................... 51
MMPR Nature of Allegation Codes .......................................................................................................................... 52
Table 135 - MMPR Nature of Allegation Codes.................................................................................................................................... 52
MMPR Report Type Codes ..................................................................................................................................... 52
Table 136 - MMPR Report Type Codes ................................................................................................................................................ 52
MMPR Outcome Codes ........................................................................................................................................... 53
Table 137 - MMPR Outcome Codes ...................................................................................................................................................... 53
MMPR Specific Allegation Codes ............................................................................................................................ 54
Table 138 - Failure to Take Appropriate Action .................................................................................................................................... 54
Table 139 - Delay In Performance ......................................................................................................................................................... 54
Table 140 - Error/Improper Performance ............................................................................................................................................... 54
Table 141 - Unnecessary/Contraindicated Procedure ............................................................................................................................ 54
Table 142 - Communication/Supervision .............................................................................................................................................. 54
Table 143 - Continuity of Care/Care Management ................................................................................................................................ 54
Table 144 - Behavior/Legal ................................................................................................................................................................... 54
Table 145 - Other ................................................................................................................................................................................... 55
MMPR Relationship of Entity Codes ....................................................................................................................... 55
Table 146 - MMPR Relationship of Entity Codes ................................................................................................................................. 55
MMPR Relationship of Entity Codes (Old Format) .................................................................................................. 55
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Table 147 - MMPR Relationship of Entity Codes (Old Format) ........................................................................................................... 55
MMPR Payment Result Of Codes ........................................................................................................................... 56
Table 148 - MMPR Payment Result Of Codes ...................................................................................................................................... 56
MMPR Payment Result Of Codes (Old Format) ..................................................................................................... 56
Table 149 - MMPR Payment Result Of Codes (Old Format) ................................................................................................................ 56
MMPR Payment Type Codes .................................................................................................................................. 57
Table 150 - MMPR Payment Type Codes ............................................................................................................................................. 57
MMPR Patient Type Codes ..................................................................................................................................... 57
Table 151 - MMPR Patient Type Codes ................................................................................................................................................ 57
Report Transaction Type Codes .............................................................................................................................. 58
Table 152 - Report Transaction Type Codes .......................................................................................................................................... 58
Void Reason Codes ................................................................................................................................................. 59
Table 153 - Void Reason Codes............................................................................................................................................................. 59
Subject Source Codes ............................................................................................................................................. 59
Table 154 - Subject Source Codes ......................................................................................................................................................... 59
Transaction Codes ................................................................................................................................................... 60
Table 155 - Transaction Codes .............................................................................................................................................................. 60
Query Purpose Codes ............................................................................................................................................. 61
Table 156 - Query Purpose Codes ......................................................................................................................................................... 61
Continuous Query Enrollment Purpose Codes ....................................................................................................... 61
Table 157 - Continuous Query Enrollment Purpose Codes .................................................................................................................... 61
Continuous Query Enrollment Status Codes ........................................................................................................... 61
Table 158 - Continuous Query Enrollment Status Codes ....................................................................................................................... 61
Continuous Query Report Disclosure Reason Codes ............................................................................................. 62
Table 159 - Continuous Query Report Disclosure Reason Codes .......................................................................................................... 62
Occupation/Field of Licensure Codes ...................................................................................................................... 64
Table 160 – Physician ............................................................................................................................................................................ 64
Table 161 – Nurse – Advanced, Registered, Practical, or Vocational .................................................................................................... 64
Table 162 – Nurse Aide, Home Health Aide and Other Aide ................................................................................................................ 64
Table 163 – Dental Service Practitioner ................................................................................................................................................ 64
Table 164 – Chiropractor ....................................................................................................................................................................... 64
Table 165 – Behavioral Health Occupations .......................................................................................................................................... 64
Table 166 – Dietitian/Nutritionist .......................................................................................................................................................... 64
Table 167 – Emergency Medical Technician (EMT) ............................................................................................................................. 64
Table 168 – Eye and Vision Service Practitioner ................................................................................................................................... 64
Table 169 – Pharmacy Service Practitioner ........................................................................................................................................... 64
Table 170 – Physician Assistant ............................................................................................................................................................ 64
Table 171 – Podiatric Service Practitioner ............................................................................................................................................. 65
Table 172 – Psychologist/Psychological Assistant ................................................................................................................................ 65
Table 173 – Rehabilitative, Respiratory and Restorative Service Practitioner ....................................................................................... 65
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Table 174 – Social Worker .................................................................................................................................................................... 65
Table 175 – Speech, Language and Hearing Service Practitioner .......................................................................................................... 65
Table 176 – Technologist/Technician .................................................................................................................................................... 65
Table 177 – Other Health Care Practitioner ........................................................................................................................................... 65
Table 178 – Health Care Facility Administrator
1
................................................................................................................................... 65
Table 179 – Other Occupation
1
.............................................................................................................................................................. 65
Occupation/Field of Licensure Codes – Retired ...................................................................................................... 66
Table 180 – Occupation/Field of Licensure Codes – Retired ................................................................................................................. 66
Specialty Codes ....................................................................................................................................................... 67
Table 181 - Physician Specialties .......................................................................................................................................................... 67
Table 182 - Dental Specialties ............................................................................................................................................................... 67
Entity Status Codes ................................................................................................................................................. 68
Table 183 - Entity Status Codes ............................................................................................................................................................. 68
State Abbreviations and U.S. Territories ................................................................................................................. 69
Table 184 – States .................................................................................................................................................................................. 69
Table 185 - Territories ........................................................................................................................................................................... 69
Table 186 - Armed Forces ..................................................................................................................................................................... 69
APO/FPO Postal Codes ....................................................................................................................................... 70
Table 187 - AE - Europe ........................................................................................................................................................................ 70
Table 188 - AA - Americas .................................................................................................................................................................... 70
Table 189 - AP - Pacific ......................................................................................................................................................................... 70
Type of Organization Codes .................................................................................................................................... 71
Table 190 - Group or Practice ................................................................................................................................................................ 71
Table 191 - Home Health Agency/ Organization ................................................................................................................................... 71
Table 192 - Hospice/Hospice Care Provider .......................................................................................................................................... 71
Table 193 - Hospital .............................................................................................................................................................................. 71
Table 194 - Hospital Unit ...................................................................................................................................................................... 71
Table 195 - Laboratory/CLIA Laboratory .............................................................................................................................................. 71
Table 196 - Nursing Facility/Skilled Nursing Facility ........................................................................................................................... 71
Table 197 - Research Center/Facility ..................................................................................................................................................... 71
Table 198 - Ambulance Service/Transportation Company .................................................................................................................... 71
Table 199 - Health Insurance Company/Provider .................................................................................................................................. 71
Table 200 - Other Health Care Facility .................................................................................................................................................. 71
Table 201 - Managed Care Organization ............................................................................................................................................... 71
Table 202 - Health Care Supplier/Manufacturer .................................................................................................................................... 71
Table 203 - Other ................................................................................................................................................................................... 71
Report Change Notification Disclosure Type Codes ............................................................................................... 72
Table 204 - Report Change Notification Disclosure Type Codes .......................................................................................................... 72
Gender Codes ......................................................................................................................................................... 74
Table 205 - Gender Codes ..................................................................................................................................................................... 74
Dispute Status Codes .............................................................................................................................................. 74
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Table 206 - Dispute Status Codes .......................................................................................................................................................... 74
Statutory Authority Codes ........................................................................................................................................ 74
Table 207 – Statutory Authority QRXS Codes ...................................................................................................................................... 74
Error Codes ............................................................................................................................................................. 75
Table 208 - Error Codes ......................................................................................................................................................................... 75
QRXS Client Program Status Codes ....................................................................................................................... 91
Table 209 - QRXS Client Program Status Codes ................................................................................................................................... 91
QRXS Web Service Status Codes .......................................................................................................................... 93
Table 210 - QRXS Web Service Status Codes ....................................................................................................................................... 93
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December 2022 1
AAR Adverse Action Classification Codes - Individual Subjects
Clinical Privileges Actions
Table 2 - Clinical Privileges - Actions
Code
Description
1610
Revocation of Clinical Privileges
1615
Termination of Panel Membership or Employment (Professional Review Action)
1630
Suspension of Clinical Privileges
1632
Summary or Emergency Suspension of Clinical Privileges
1634
Voluntary Limitation, Restriction, or Reduction of Clinical Privilege(s) While Under, or to Avoid, Investigation
Relating to Professional Competence or Conduct
1635
Voluntary Surrender of Clinical Privilege(s), While Under, or to Avoid, Investigation Relating to Professional
Competence or Conduct
1637
Involuntary Resignation
1638
Voluntary Leave of Absence, While Under, or to Avoid, Investigation
1639
Summary or Emergency Limitation, Restriction, or Reduction of Clinical Privileges
1640
Reduction of Clinical Privileges
1642
Limitation or Restriction on Certain Procedure(s) or Practice Area(s)
1643
Limitation or Restriction: Mandatory Concurring Consultation Prior to Procedures
1644
Limitation or Restriction: Mandatory Proctoring or Monitoring During Procedures
1645
Other Restriction/Limitation of Clinical Privileges, Specify, _________________
1650
Denial of Clinical Privileges
1655
Failure to Apply for Renewal or Withdrawal of Renewal Application While Under Investigation
1656
Practitioner Allowed Privileges to Expire While Under Investigation
Table 3 - Clinical Privileges - Revisions to Actions (No Basis for Action Codes Required)
Code
Description
1610
Revocation of Clinical Privileges
1615
Termination of Panel Membership or Employment (Professional Review Action)
1630
Suspension of Clinical Privileges
1632
Summary or Emergency Suspension of Clinical Privileges
1634
Voluntary Limitation, Restriction, or Reduction of Clinical Privilege(s) While Under, or to Avoid, Investigation
Relating to Professional Competence or Conduct
1635
Voluntary Surrender of Clinical Privilege(s), While Under, or to Avoid, Investigation Relating to Professional
Competence or Conduct
1637
Involuntary Resignation
1638
Voluntary Leave of Absence, While Under, or to Avoid, Investigation
1639
Summary or Emergency Limitation, Restriction, or Reduction of Clinical Privileges
1640
Reduction of Clinical Privileges
1642
Limitation or Restriction on Certain Procedure(s) or Practice Area(s)
1643
Limitation or Restriction: Mandatory Concurring Consultation Prior to Procedures
1644
Limitation or Restriction: Mandatory Proctoring or Monitoring During Procedures
1645
Other Restriction/Limitation of Clinical Privileges, Specify, _________________
1655
Failure to Apply for Renewal or Withdrawal of Renewal Application While Under Investigation
1656
Practitioner Allowed Privileges to Expire While Under Investigation
1680
Clinical Privileges Restored or Reinstated, Complete
1681
Clinical Privileges Restored or Reinstated, Conditional
1682
Clinical Privileges Restored or Reinstated, Partial
1689
Clinical Privileges Restoration or Reinstatement Denied
1690
Reduction of Previous Action
1695
Extension of Previous Action
1696
Modification of Previous Action
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December 2022 2
Exclusion or Debarment Actions
Table 4 - Exclusion or Debarment - Actions
Code
Description
1500
Debarment From Federal Programs
1505
Exclusion From a Federal Health Care Program
1507
Exclusion From a State Health Care Program
1508
Exclusion From Medicare, Medicaid and All Other Federal Health Care Programs
1
1509
Exclusion From Medicare and State Health Care Programs
1
Table 5 - Exclusion or Debarment - Revisions to Actions (No Basis for Action Codes Required)
Code
Description
1514
Modification of Previous Action
1515
Reinstatement
1516
Reinstatement Denied
1
These codes are for the HHS Office of Inspector General (OIG) use only. In cases in which the HHS OIG submits
an Exclusion or Debarment action, the HHS OIG may not select multiple Adverse Action Classification Codes when
reporting either of the following two codes: Exclusion from Medicare, Medicaid and all other Federal Health Care
Programs, or Exclusion from Medicare and State Health Care Programs. Additional actions should be submitted in
separate reports.
All other reporters of Exclusion or Debarment actions may select any available Adverse Action Classification Code alone
or in combination, except for the two codes noted above.
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December 2022 3
Federal Licensure Actions
Table 6 - Licensure - Actions
Code
Description
1110
Revocation of License
1125
Probation of License
1135
Suspension of License
1140
Reprimand or Censure
1145
Voluntary Surrender of License
1146
Voluntary Limitation or Restriction on License
1147
Limitation or Restriction on License
1148
Denial of License Renewal
1149
Denial of Initial License
1
1155
Failure to Apply for Renewal or Withdrawal of Renewal Application While Under Investigation
1173
Publicly Available Fine/Monetary Penalty
1
1189
Publicly Available Negative Action or Finding Specify, ____
1199
Other Licensure Action - Not Classified, Specify, ____________________
Table 7 - Licensure - Revisions to Actions (No Basis for Action Codes Required)
Code
Description
1110
Revocation of License
1125
Probation of License
1135
Suspension of License
1140
Reprimand or Censure
1145
Voluntary Surrender of License
1146
Voluntary Limitation or Restriction on License
1147
Limitation or Restriction on License
1155
Failure to Apply for Renewal or Withdrawal of Renewal Application While Under Investigation
1173
Publicly Available Fine/Monetary Penalty
1
1189
Publicly Available Negative Action or Finding, Specify, ____
1
1199
Other Licensure Action - Not Classified, Specify, ____________________
1280
License Restored or Reinstated, Complete
1282
License Restored or Reinstated, Conditional
1283
License Restored or Reinstated, Partial
1285
License Restoration or Reinstatement Denied
1295
Reduction of Previous Licensure Action
1296
Extension of Previous Licensure Action
1297
Modification of Previous Licensure Action
1
In cases in which the Drug Enforcement Administration (DEA) submits a Federal Licensure action on a health care
practitioner, the DEA may not select multiple Adverse Action Classification Codes when reporting any one of the
following codes: 1149 Denial of Initial License, 1173 Publicly Available Fine/Monetary Penalty, or 1189 Publicly
Available Negative Action or Finding. Additional actions should be submitted in separate reports.
When reporting on a subject other than a practitioner, the DEA may select any Federal Licensure Adverse Action
Classification Code singly or in combination.
All other reporters submitting a Federal Licensure action may select any available Adverse Action Classification Code
alone or in combination for any type of subject.
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December 2022 4
Government Administrative Actions
Table 8 - Government Administrative - Actions Related to Certification Agreements or Contracts for Participation in a
Federal or State Health Care Program
Code
Description
1510
Termination of Medicare or Other Federal Health Care Program Participation
1512
Voluntary Termination of Medicare or Other Federal Health Care Program Participation After Notification of
Investigation or Disciplinary Action
1513
Nonrenewal of Medicare or Other Federal Health Care Program Participation Agreement for Cause
1517
Voluntary Termination of Medicaid or Other State Health Care Program Participation After Notification of
Investigation or Disciplinary Action
1518
Nonrenewal of Medicaid or Other State Health Care Program Participation Agreement for Cause
1525
Denial of Initial Application
1531
Civil Money Penalty Imposed by a Federal or State Health Care Program
1533
Administrative Fine/Monetary Penalty Imposed by a Federal or State Health Care Program
1551
Termination of Medicaid or Other State Health Care Program Participation
1555
Employment Disqualification Based on Finding in State Nurse Aide Registry
1556
Negative Finding or Listing in a State Health Care Practitioner Registry
1579
Other Action Imposed by Medicaid or Other State Health Care Program- Not Classified, Specify,
1598
Other Action Imposed by Medicare or Other Federal Health Care Program- Not Classified, Specify,
1599
Other Certification Action – Not Classified, Specify, ____________________
Table 9 - Government Administrative - Other Adjudicated Actions or Decisions by a Federal or State Agency
Code
Description
1521
Contract Termination
1536
Administrative Fine/Monetary Penalty
1539
Civil Money Penalty
1552
Disqualification of Clinical Investigator From Receiving Investigational Products
1561
Personnel Action - Employee Termination
1563
Personnel Action - Employee Suspension
1566
Personnel Action - Not Classified, Specify, _____
1588
Other Adjudicated Action or Decision – Not Classified, Specify, _____
Table 10 - Government Administrative - Revisions to Actions (No Basis for Action Code Required) - Actions Related
to Certification Agreements or Contracts for Participation in a Federal or State Health Care Program
Code
Description
1510
Termination of Medicare or Other Federal Health Care Program Participation
1512
Voluntary Termination of Medicare or Other Federal Health Care Program Participation After Notification of
Investigation or Disciplinary Action
1517
Voluntary Termination of Medicaid or Other State Health Care Program Participation After Notification of
Investigation or Disciplinary Action
1531
Civil Money Penalty Imposed by a Federal or State Health Care Program
1533
Administrative Fine/Monetary Penalty Imposed by a Federal or State Health Care Program
1551
Termination of Medicaid or Other State Health Care Program Participation
1555
Employment Disqualification Based on Finding in State Nurse Aide Registry
1556
Negative Finding or Listing in a State Health Care Practitioner Registry
1579
Other Action Imposed by Medicaid or Other State Health Care Program- Not Classified, Specify,
1590
Reinstatement
1592
Reinstatement Denied
1595
Reduction of Previous Action
1596
Extension of Previous Action
1597
Modification of Previous Action
1598
Other Action Imposed by Medicare or Other Federal Health Care Program- Not Classified, Specify,
1599
Other Certification Action – Not Classified, Specify
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December 2022 5
Table 11 - Government Administrative - Revisions to Actions (No Basis for Action Code Required) - Other Adjudicated
Actions or Decisions by a Federal or State Agency
Code
Description
1521
Contract Termination
1536
Administrative Fine/Monetary Penalty
1539
Civil Money Penalty
1552
Disqualification of Clinical Investigator From Receiving Investigational Products
1561
Personnel Action - Employee Termination
1563
Personnel Action - Employee Suspension
1566
Personnel Action - Not Classified, Specify, _____
1580
Reinstatement
1581
Reinstatement Denied
1582
Reduction of Previous Action
1583
Extension of Previous Action
1584
Modification of Previous Action
1588
Other Adjudicated Action or Decision – Not Classified, Specify, _____
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December 2022 6
Health Plan Actions
Table 12 - Health Plan Action - Actions
Code
Description
1920
Contract Termination
1930
Suspension of Contract
1931
Contract Restriction
1932
Administrative Fine/Monetary Penalty
1941
Employment Termination
1942
Employment Suspension
1951
Denial of Initial Contract Application
1952
Denial of Contract Renewal
1989
Other Health Plan Action, Specify, ___________________
Table 13 - Health Plan Action - Revisions to Actions (No Basis for Action Code Required)
Code
Description
1920
Contract Termination
1930
Suspension of Contract
1931
Contract Restriction
1932
Administrative Fine/Monetary Penalty
1941
Employment Termination
1942
Employment Suspension
1989
Other Health Plan Action, Specify, ___________________
1990
Reinstatement
1992
Reinstatement Denied
1995
Reduction of Previous Action
1996
Extension of Previous Action
1997
Modification of Previous Action
Professional Society Actions
Table 14 - Professional Society - Actions
Code
Description
1710
Revocation of Professional Society Membership
1730
Suspension of Professional Society Membership
1735
Disciplinary Probation Affecting Membership Rights or Privileges
1745
Other Restriction/Limitation on Professional Society Membership, Specify, ____________________
1750
Denial of Professional Society Membership (Subsequent)
Table 15 - Professional Society - Revisions to Actions (No Basis for Action Code Required)
Code
Description
1710
Revocation of Professional Society Membership
1730
Suspension of Professional Society Membership
1735
Disciplinary Probation Affecting Membership Rights or Privileges
1745
Other Restriction/Limitation on Professional Society Membership, Specify, ____________________
1780
Membership Reinstated, Complete
1781
Membership Reinstated, Conditional
1789
Membership Reinstatement Denied
1790
Reduction of Previous Action
1795
Extension of Previous Action
1796
Modification of Previous Action
Code Lists Version 2.10
December 2022 7
State Licensure or Certification Actions
Table 16 - Licensure - Actions
Code
Description
1110
Revocation of License
1125
Probation of License
1135
Suspension of License
1138
Summary or Emergency Limitation or Restriction on License
1,2
1139
Summary or Emergency Suspension of License
1,2
1140
Reprimand or Censure
1145
Voluntary Surrender of License
1146
Voluntary Limitation or Restriction on License
1147
Limitation or Restriction on License
1148
Denial of License Renewal
1149
Denial of Initial License
1150
Interim Action - Voluntary Agreement to Refrain from Practice or to Suspend License Pending Completion of an
Investigation
1151
Cease and Desist
1155
Failure to Apply for Renewal or Withdrawal of Renewal Application While Under Investigation
1173
Publicly Available Fine/Monetary Penalty
1179
Limitation or Restriction on Ability to Prescribe, Dispense, or Administer Medication or Sedation, Specify,
____________________
1189
Publicly Available Negative Action or Finding Specify, ____
1
1199
Other Licensure Action - Not Classified, Specify, ____________________
Table 17 - Licensure - Revisions to Actions (No Basis for Action Codes Required)
Code
Description
1110
Revocation of License
1125
Probation of License
1135
Suspension of License
1138
Summary or Emergency Limitation or Restriction on License
1,2
1139
Summary or Emergency Suspension of License
1,2
1140
Reprimand or Censure
1145
Voluntary Surrender of License
1146
Voluntary Limitation or Restriction on License
1147
Limitation or Restriction on License
1150
Interim Action - Voluntary Agreement to Refrain from Practice or to Suspend License Pending Completion of an
Investigation
1151
Cease and Desist
1155
Failure to Apply for Renewal or Withdrawal of Renewal Application While Under Investigation
1173
Publicly Available Fine/Monetary Penalty
1179
Limitation or Restriction on Ability to Prescribe, Dispense, or Administer Medication or Sedation, Specify,
____________________
1189
Publicly Available Negative Action or Finding Specify, ____
1
1199
Other Licensure Action - Not Classified, Specify, ____________________
1280
License Restored or Reinstated, Complete
1282
License Restored or Reinstated, Conditional
1283
License Restored or Reinstated, Partial
1285
License Restoration or Reinstatement Denied
1295
Reduction of Previous Licensure Action
1296
Extension of Previous Licensure Action
1297
Modification of Previous Licensure Action
Code Lists Version 2.10
December 2022 8
State Licensure or Certification Actions (continued)
Table 18 - Licensure - Multi-State Privilege Actions
3
Code
Description
1310
Revocation of Multi-State Licensure Privilege
1325
Probation of Multi-State Licensure Privilege
1335
Suspension of Multi-State Licensure Privilege
1338
Summary or Emergency Limitation or Restriction of Multi-State Licensure Privilege
1339
Summary or Emergency Suspension of Multi-State Licensure Privilege
1340
Reprimand or Censure of Multi-State Licensure Privilege
1345
Voluntary Surrender of Multi-State Licensure Privilege
1346
Voluntary Limitation or Restriction on Practice Authorized by Multi-State Licensure Privilege
1347
Limitation or Restriction on Multi-State Licensure Privilege
1351
Cease and Desist – Multi-State Licensing Privilege
1373
Publicly Available Fine/Monetary Penalty Concerning Practicing under Multi-State Licensure Privilege
1389
Publicly Available Negative Action or Finding Concerning Practicing under Multi-State Licensure Privilege, Specify,
________
1399
Other Action Against Practitioner Practicing Under Multi-State Licensure Privilege - Not Classified, Specify, ___
Table 19 - Licensure - Revisions to Multi-State Privilege Actions (No Basis for Action Codes Required)
3
Code
Description
1310
Revocation of Multi-State Licensure Privilege
1325
Probation of Multi-State Licensure Privilege
1335
Suspension of Multi-State Licensure Privilege
1338
Summary or Emergency Limitation or Restriction of Multi-State Licensure Privilege
1339
Summary or Emergency Suspension of Multi-State Licensure Privilege
1340
Reprimand or Censure of Multi-State Licensure Privilege
1345
Voluntary Surrender of Multi-State Licensure Privilege
1346
Voluntary Limitation or Restriction on Practice Authorized by Multi-State Licensure Privilege
1347
Limitation or Restriction on Multi-State Licensure Privilege
1351
Cease and Desist – Multi-State Licensing Privilege
1373
Publicly Available Fine/Monetary Penalty Concerning Practicing under Multi-State Licensure Privilege
1389
Publicly Available Negative Action or Finding Concerning Practicing under Multi-State Licensure Privilege, Specify,
________
1399
Other Action Against Practitioner Practicing Under Multi-State Licensure Privilege – Not Classified, Specify, ___
1480
Multi-State Licensure Privilege Restored or Reinstated, Complete
1482
Multi-State Licensure Privilege Restored or Reinstated, Conditional
1483
Multi-State Licensure Privilege Restored or Reinstated, Partial
1485
Multi-State Licensure Privilege Restoration or Reinstatement Denied
1495
Reduction of Previous Multi-State Licensure Privilege Action
1496
Extension of Previous Multi-State Licensure Privilege Action
1497
Modification of Previous Multi-State Licensure Privilege Action
1
For State Licensure or Certification Actions against practitioners you may not select multiple Adverse Action
Classification Codes when reporting any one of the following codes: 1138 Summary or Emergency Limitation or
Restriction on License, 1139 Summary or Emergency Suspension of License, 1149 Denial of Initial License, or 1189
Publicly Available Negative Action or Finding. Additional actions should be submitted in separate reports. You may
select all other Adverse Action Classification Codes available, in any combination, up to the five allowable codes.
2
Codes 1138 and 1139 against physicians and dentists must be based on the professional competence or conduct of
the subject.
3
Multi-State licensure privilege codes are only valid for actions against practitioners when such actions are being taken by a
remote state subject to a multi-state Licensure Compact. These codes cannot be used by the state which issued the license,
nor can they be used in conjunction with any Licensure Actions.
Code Lists Version 2.10
December 2022 9
AAR Adverse Action Classification Codes (Old Format)
(For Initial Reports submitted through August 14, 2000 using an earlier reporting format.)
Table 20 - AAR Adverse Action Classification Codes
(Old Format)
Code
Description
10000
License Revoked
10100
License Revoked: Alcohol and Other Substance Abuse
10200
License Revoked:
Incompetence/Malpractice/Negligence
10300
License Revoked: Narcotics Violations
10400
License Revoked: Felony
10500
License Revoked: Fraud
11000
License Revoked: Unprofessional Conduct
12000
License Revoked: Mental Disorder
13000
License Revoked: Allowing Unlicensed Person to
Practice
15000
License Revoked: Disciplinary Action in Another State
18000
License Revoked: Other Reason - Not Classified
20000
License Probation
20100
License Probation: Alcohol and Other Substance Abuse
20200
License Probation:
Incompetence/Malpractice/Negligence
20300
License Probation: Narcotics Violations
20400
License Probation: Felony
20500
License Probation: Fraud
21000
License Probation: Unprofessional Conduct
22000
License Probation: Mental Disorder
23000
License Probation: Allowing Unlicensed Person to
Practice
25000
License Probation: Disciplinary Action in Another State
28000
License Probation: Other Reason - Not Classified
30000
License Suspended
30100
License Suspended: Alcohol and Other Substance
Abuse
30200
License Suspended:
Incompetence/Malpractice/Negligence
30300
License Suspended: Narcotics Violations
30400
License Suspended: Felony
30500
License Suspended: Fraud
31000
License Suspended: Unprofessional Conduct
32000
License Suspended: Mental Disorder
33000
License Suspended: Allowing Unlicensed Person to
Practice
35000
License Suspended: Disciplinary Action in Another State
38000
License Suspended: Other Reason - Not Classified
40000
License-Miscellaneous
40100
License-Misc.: License Restored or Reinstated
40200
License-Misc.: Reinstatement Denied
40600
License-Misc.: Reprimand
41000
License-Misc.: Other Misc. Action (Inc. Censure &
Surrender)
41200
License-Misc.: License Denied (Renewal Only)
60000
Code/Clinical Privileges
61000
Clinic Privileges Revoked
61001
Clinic Priv Revoked: Alcohol and Other Substance
Abuse
61002
Clinic Priv Revoked:
Incompetence/Malpractice/Negligence
61003
Clinic Priv Revoked: Narcotics Violations
61004
Clinic Priv Revoked: Felony
61005
Clinic Priv Revoked: Fraud
61010
Clinic Priv Revoked: Unprofessional Conduct
Code
Description
61020
Clinic Priv Revoked: Mental Disorder
61030
Clinic Priv Revoked: Allowing Unlicensed Person to
Practice
61050
Clinic Priv Revoked: Disciplinary Action in Another State
61080
Clinic Priv Revoked: Physical Impairment
61090
Clinic Priv Revoked: Other
63000
Clinic Privileges Suspended
63001
Privs Suspended: Alcohol and Other Substance Abuse
63002
Privs Suspended: Incompetence/Malpractice/Negligence
63003
Privs Suspended: Narcotics Violations
63004
Privs Suspended: Felony
63005
Privs Suspended: Fraud
63010
Privs Suspended: Unprofessional Conduct
63020
Privs Suspended: Mental Disorder
63030
Privs Suspended: Allowing Unlicensed Person to
Practice
63050
Privs Suspended: Disciplinary Action in Another State
63080
Privs Suspended: Physical Impairment
63090
Privs Suspended: Other
63500
Voluntary Surrender of Privileges
63501
Vol Surr of Priv: Alcohol and Other Substance Abuse
63502
Vol Surr of Priv: Incompetence/Malpractice/Negligence
63503
Vol Surr of Priv: Narcotics Violations
63504
Vol Surr of Priv: Felony
63505
Vol Surr of Priv: Fraud
63510
Vol Surr of Priv: Unprofessional Conduct
63520
Vol Surr of Priv: Mental Disorder
63530
Vol Surr of Priv: Allowing Unlicensed Person to Practice
63550
Vol Surr of Priv: Disciplinary Action in Another State
63580
Vol Surr of Priv: Physical Impairment
63590
Vol Surr of Priv: Other
64000
Clinical Privileges Reduced
64001
Clinic Priv Reduced: Alcohol and Other Substance
Abuse
64002
Clinic Priv Reduced:
Incompetence/Malpractice/Negligence
64003
Clinic Priv Reduced: Narcotics Violations
64004
Clinic Priv Reduced: Felony
64005
Clinic Priv Reduced: Fraud
64010
Clinic Priv Reduced: Unprofessional Conduct
64020
Clinic Priv Reduced: Mental Disorder
64030
Clinic Priv Reduced: Allowing Unlicensed Person to
Practice
64050
Clinic Priv Reduced: Disciplinary Action in Another State
64080
Clinic Priv Reduced: Physical Impairment
64090
Clinic Priv Reduced: Other
64500
Other Clinical Privileges Restriction
64501
Other Priv Restrict: Alcohol and Other Substance Abuse
64502
Other Priv Restrict:
Incompetence/Malpractice/Negligence
64503
Other Priv Restrict: Narcotics Violations
64504
Other Priv Restrict: Felony
64505
Other Priv Restrict: Fraud
64510
Other Priv Restrict: Unprofessional Conduct
64520
Other Priv Restric: Mental Disorder
64530
Other Priv Restrict: Allowing Unlicensed Person to
Practice
64550
Other Priv Restrict: Disciplinary Action in Another State
64580
Other Priv Restrict: Physical Impairment
64590
Other Priv Restrict: Other (Inc. Probation Restricting
Priv)
Code Lists Version 2.10
December 2022 10
AAR Adverse Action Classification Codes - Old Format (continued)
Table 21 - AAR Adverse Action Classification Codes -
Old Format (continued)
Code
Description
65000
Clinical Privileges Denial
65001
Denial-Privs: Alcohol and Other Substance Abuse
65002
Denial-Privs: Incompetence/Malpractice/Negligence
65003
Denial-Privs: Narcotics Violations
65004
Denial-Privs: Felony
65005
Denial-Privs: Fraud
65010
Denial-Privs: Unprofessional Conduct
65020
Denial-Privs: Mental Disorder
65030
Denial-Privs: Allowing Unlicensed Person to Practice
65050
Denial-Privs: Disciplinary Action Taken in Another State
65080
Denial-Privs: Physical Impairment
65090
Denial-Privs: Other
68000
Revision-Privs: Reinstatement, Complete
68100
Revision-Privs: Reinstatement, Conditional
68900
Revision-Privs: Reinstatement Denied
69000
Revision-Privs: Reduction of Previous Action
69500
Revision-Privs: Extension of Previous Action
69900
Revision-Privs: Reversal of Action Due to Appeal or
Review
71000
Professional Society Membership Revoked
71001
Prof Society Revoked: Alcohol and Other Substance
Abuse
71002
Prof Society Revoked:
Incompetence/Malpractice/Negligence
71003
Prof Society Revoked: Narcotics Violations
71004
Prof Society Revoked: Felony
71005
Prof Society Revoked: Fraud
71010
Prof Society Revoked: Unprofessional Conduct
71020
Prof Society Revoked: Mental Disorder
71030
Prof Society Revoked: Allowing Unlicensed Person to
Practice
71050
Prof Society Revoked: Disciplinary Action in Another
State
71080
Prof Society Revoked: Physical Impairment
71090
Prof Society Revoked: Other
73000
Professional Society Membership Suspended
73001
Prof Soc. Suspended: Alcohol and Other Substance
Abuse
73002
Prof Soc. Suspended:
Incompetence/Malpractice/Negligence
73003
Prof Soc. Suspended: Narcotics Violations
73004
Prof Soc. Suspended: Felony
73005
Prof Soc. Suspended: Fraud
73010
Prof Soc. Suspended: Unprofessional Conduct
Code
Description
73020
Prof Soc. Suspended: Mental Disorder
73030
Prof Soc. Suspended: Allowing Unlicensed Person to
Practice
73050
Prof Soc. Suspended: Disciplinary Action in Another
State
73080
Prof Soc. Suspended: Physical Impairment
73090
Prof Soc. Suspended: Other
74500
Other Restrictions - Professional Society Membership
74501
Prof Soc Other Rest: Alcohol and Other Substance
Abuse
74502
Prof Soc Other Rest:
Incompetence/Malpractice/Negligence
74503
Prof Soc Other Rest: Narcotics Violations
74504
Prof Soc Other Rest: Felony
74505
Prof Soc Other Rest: Fraud
74510
Prof Soc Other Rest: Unprofessional Conduct
74520
Prof Soc Other Rest: Mental Disorder
74530
Prof Soc Other Rest: Allowing Unlicensed Person to
Practice
74550
Prof Soc Other Rest: Disciplinary Action in Another
State
74580
Prof Soc Other Rest: Physical Impairment
74590
Prof Soc Other Rest: Other (Inc Probation Restricting
Privs)
75000
Denial-Professional Society Membership
75001
Denial-Prof Society: Alcohol and Other Substance
Abuse
75002
Denial-Prof Society:
Incompetence/Malpractice/Negligence
75003
Denial-Prof Society: Narcotics Violations
75004
Denial-Prof Society: Felony
75005
Denial-Prof Society: Fraud
75010
Denial-Prof Society: Unprofessional Conduct
75020
Denial-Prof Society: Mental Disorder
75030
Denial-Prof Society: Allowing Unlicensed Person to
Practice
75050
Denial-Prof Society: Disciplinary Action in Another State
75080
Denial-Prof Society: Physical Impairment
75090
Denial-Prof Society: Other
78000
Revision-Prof Society: Reinstatement, Complete
78100
Revision-Prof Society: Reinstatement, Conditional
78900
Revision-Prof Society: Reinstatement Denied
79000
Revision-Prof Society: Reduction of Previous Action
79500
Revision-Prof Society: Extension of Previous Action
79900
Revision-Prof Society: Reversal of Previous Action
Code Lists Version 2.10
December 2022 11
AAR Adverse Action Classification Codes - Organization Subjects
Accreditation Actions
Table 22 - Accreditation Actions
Code
Description
3850
Accreditation Award Revoked
3855
Non-Accreditation/Denial of Accreditation
3864
Accreditation Restoration or Reinstatement Denied
3859
Other Private Accreditation Action - Not Classified, Specify, _________________
Table 23 - Accreditation Revisions to Actions (No Basis for Action Codes Required)
Code
Description
3860
Accreditation
3862
Accreditation Restored or Reinstated, Conditional
Exclusion or Debarment Actions
Table 24 - Exclusion or Debarment Actions
Code
Description
3500
Debarment From Federal Programs
3505
Exclusion From a Federal Health Care Program
3507
Exclusion From a State Health Care Program
3508
Exclusion From Medicare, Medicaid and All Other Federal Health Care Programs
1
3509
Exclusion From Medicare and State Health Care Programs
1
Table 25 - Exclusion or Debarment Revisions to Actions (No Basis for Action Code Required)
Code
Description
3515
Reinstatement
3516
Reinstatement Denied
3519
Modification of Previous Action
1
These codes are for the HHS Office of Inspector General (OIG) use only. In cases in which the HHS OIG submits
an Exclusion or Debarment action, the HHS OIG may not select multiple Adverse Action Classification Codes when
reporting either of the following two codes: Exclusion from Medicare, Medicaid and all other Federal Health Care
Programs, or Exclusion from Medicare and State Health Care Programs. Additional actions should be submitted in
separate reports.
All other reporters of Exclusion or Debarment actions may select any available Adverse Action Classification Code alone
or in combination except for the two codes noted above.
Code Lists Version 2.10
December 2022 12
Federal Licensure, State Licensure or Certifications Actions
Table 26 - Licensure Actions
Code
Description
3111
Revocation of License or Certificate
3136
Suspension of License or Certificate
3138
Reprimand or Censure
3141
Voluntary Surrender of License or Certificate
3143
Conditional, Provisional, or Probationary License or Certificate
3144
Denial of License or Certificate Renewal
3145
Denial of Initial License or Certificate
3202
Directed Plan of Correction
3203
On-Site Monitoring
3204
Monitoring
3205
Directed In-Service Training
3206
Appointment of Temporary Management
3207
Restrictions on Admissions or Services
3210
Closure of Facility
3212
Transfer of Residents to Other Facilities Without Closure of the Facility
3220
Receivership
3225
Liquidation
3230
Civil Money Penalty
3233
Publicly Available Fine/Monetary Penalty
3238
Summary or Emergency Action, Specify
3239
Other Licensure Action - Not Classified, Specify, _________________
Table 27 - Licensure Revisions to Actions (No Basis for Action Codes Required)
Code
Description
3111
Revocation of License or Certificate
3136
Suspension of License or Certificate
3138
Reprimand or Censure
3141
Voluntary Surrender of License or Certificate
3143
Conditional, Provisional, or Probationary License or Certificate
3202
Directed Plan of Correction
3203
On-Site Monitoring
3204
Monitoring
3205
Directed In-Service Training
3206
Appointment of Temporary Management
3207
Restrictions on Admissions or Services
3210
Closure of Facility
3212
Transfer of Residents to Other Facilities Without Closure of the Facility
3220
Receivership
3225
Liquidation
3230
Civil Money Penalty
3233
Publicly Available Fine/Monetary Penalty
3238
Summary or Emergency Action, Specify
3239
Other Licensure Action - Not Classified, Specify, _________________
3281
License or Certificate Restored or Reinstated, Complete
3283
License or Certificate Restored or Reinstated, Conditional
3284
License or Certificate Restored or Reinstated, Partial
3286
License or Certificate Restoration or Reinstatement Denied
3295
Reduction of Previous Licensure Action
3296
Extension of Previous Licensure Action
3297
Modification of Previous Licensure Action
Code Lists Version 2.10
December 2022 13
Government Administrative Actions
Table 28 - Government Administrative Actions - Actions Related to Certification Agreements or Contracts for
Participation in a Federal or State Health Care Program
Code
Description
3202
Directed Plan of Correction
3203
On-Site Monitoring
3205
Directed In-Service Training
3206
Appointment of Temporary Management
3207
Restrictions on Admissions or Services
3210
Closure of Facility
3212
Transfer of Residents to Other Facilities Without Closure of the Facility
3231
Civil Money Penalty Imposed by a Federal or State Health Care Program
3234
Administrative Fine/Monetary Penalty Imposed by a Federal or State Health Care Program
3510
Termination of Medicare or Other Federal Health Care Program Participation
3512
Voluntary Termination of Medicare or Other Federal Health Care Program Participation After Notification of
Investigation or Disciplinary Action
3513
Nonrenewal of Medicare or Other Federal Health Care Program Participation Agreement for Cause
3517
Voluntary Termination of Medicaid or Other State Health Care Program Participation After Notification of
Investigation or Disciplinary Action
3518
Nonrenewal of Medicaid or Other State Health Care Program Participation Agreement for Cause
3525
Denial of Initial Application
3540
Marketing Activities Suspended or Restricted
3542
Beneficiary Enrollment Suspended
3551
Termination of Medicaid or Other State Health Care Program Participation
3579
Other Action Imposed by Medicaid or Other State Health Care Program- Not Classified, Specify,
3598
Other Action Imposed by Medicare or Other Federal Health Care Program- Not Classified, Specify,
3599
Other Certification Action - Not Classified, Specify, ______________
Table 29 - Government Administrative - Other Adjudicated Actions or Decisions by a Federal or State Agency
Code
Description
3521
Contract Termination
3538
Administrative Fine/Monetary Penalty
3539
Civil Money Penalty
3588
Other Adjudicated Action or Decision Not Classified, Specify, _____
Table 30 - Government Administrative - Revisions to Actions (No Basis for Action Code Required) - Actions Related
to Certification Agreements or Contracts for Participation in a Federal or State Health Care Program
Code
Description
3202
Directed Plan of Correction
3203
On-Site Monitoring
3205
Directed In-Service Training
3206
Appointment of Temporary Management
3207
Restrictions on Admissions or Services
3210
Closure of Facility
3212
Transfer of Residents to Other Facilities Without Closure of the Facility
3231
Civil Money Penalty Imposed by a Federal or State Health Care Program
3234
Administrative Fine/Monetary Penalty Imposed by a Federal or State Health Care Program
3510
Termination of Medicare or Other Federal Health Care Program Participation
3512
Voluntary Termination of Medicare or Other Federal Health Care Program Participation After Notification of
Investigation or Disciplinary Action
3517
Voluntary Termination of Medicaid or Other State Health Care Program Participation After Notification of
Investigation or Disciplinary Action
3540
Marketing Activities Suspended or Restricted
3542
Beneficiary Enrollment Suspended
Code Lists Version 2.10
December 2022 14
Code
Description
3551
Termination of Medicaid or Other State Health Care Program Participation
3579
Other Action Imposed by Medicaid or Other State Health Care Program- Not Classified, Specify,
3590
Reinstatement
3592
Reinstatement Denied
3595
Reduction of Previous Action
3596
Extension of Previous Action
3597
Modification of Previous Action
3598
Other Action Imposed by Medicare or Other Federal Health Care Program- Not Classified, Specify,
3599
Other Certification Action - Not Classified, Specify, ______________
Table 31 - Government Administrative - Revisions to Actions (No Basis for Action Code Required) - Other Adjudicated
Actions or Decisions by a Federal or State Agency
Code
Description
3521
Contract Termination
3538
Administrative Fine/Monetary Penalty
3539
Civil Money Penalty
3580
Reinstatement
3581
Reinstatement Denied
3582
Reduction of Previous Action
3583
Extension of Previous Action
3584
Modification of Previous Action
3588
Other Adjudicated Action or Decision Not Classified, Specify, _____
Code Lists Version 2.10
December 2022 15
Health Plan Actions
Table 32 - Health Plan Action - Actions
Code
Description
3920
Contract Termination
3930
Suspension of Contract
3932
Administrative Fine/Monetary Penalty
3951
Denial of Initial Contract Application
3952
Denial of Contract Renewal
3989
Other Health Plan Action, Specify, ____________________
Table 33 - Health Plan Action - Revisions to Actions (No Basis for Action Code Required)
Code
Description
3920
Contract Termination
3930
Suspension of Contract
3932
Administrative Fine/Monetary Penalty
3989
Other Health Plan Action, Specify, ____________________
3990
Reinstatement
3992
Reinstatement Denied
3995
Reduction of Previous Action
3996
Extension of Previous Action
3997
Modification of Previous Action
Code Lists Version 2.10
December 2022 16
AAR Adverse Action Classification Codes - Retired
Table 34 - AAR Adverse Action Classification Codes - Retired
Code
Description
1172
Administrative Fine/Monetary Penalty
1348
Denial of Renewal of Multi-State Licensure Privilege
1349
Denial of Initial Multi-State Licensure Privilege
1520
Contract Termination
1530
Civil Money Penalty
1532
Administrative Fine/Monetary Penalty
1550
Disqualification of Clinical Investigator From Receiving Investigational Products
1560
Personnel Action - Employee Termination
1562
Personnel Action - Employee Suspension
1565
Personnel Action - Not Classified
1589
Other Action - Not Classified, Specify
1636
Voluntary Acceptance of Restrictions on Privileges
1699
Reversal of Previous Action Due to Appeal or Review
1799
Reversal of Previous Action Due to Appeal or Review
1831
Recommendation to Exclude from Participating in Medicare, Medicaid
1950
Denial of Contract Application or Renewal
3232
Administrative Fine/Monetary Penalty
3520
Contract Termination
3589
Other Action - Not Classified, Specify
3950
Denial of Contract Application or Renewal
Retired codes are not available for submission on new reports but may appear on existing reports.
Code Lists Version 2.10
December 2022 17
AAR Type of Negative Finding Codes - Individual Subjects
Peer Review Organization
Table 35 - Initial Actions
Code
Description
1830
Recommendation to Sanction
1889
Other Finding - Not Classified, Specify, ____________________
Table 36 - Revision to Actions
Code
Description
1840
Withdrawal of Recommendation to Sanction
1841
Withdrawal of Recommendation to Exclude from Participating in Medicare, Medicaid
Code Lists Version 2.10
December 2022 18
AAR Basis for Action Codes - Individual Subjects
Clinical Privileges Actions
Table 37 - Non-Compliance With Requirements
Code
Description
A8
Clinical Privileges Restricted, Suspended or Revoked by Another Hospital or Health Care Facility
AA
Failure to Comply With Corrective Action Plan
AH
Failure to Comply With Terms of Probation or other Previously Imposed Requirements
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
29
Practicing Beyond the Scope of Practice
AB
Practicing Beyond the Scope of Privileges
24
Practicing With an Expired License
A4
Practicing Without a Valid License
A7
Surrendered License to Practice
70
Violation of By-Laws, Protocols or Guidelines
79
Violation of Code of Ethics
Table 38 - Criminal Conviction or Adjudication
Code
Description
19
Criminal Conviction
18
Deferred Adjudication
B1
Nolo Contendere Plea
Table 39 - Confidentiality, Consent or Disclosure Violations
Code
Description
C3
Breach of Confidentiality
C2
Failure to Comply With Patient Consultation Requirements
C1
Failure to Obtain Informed Consent
Table 40 - Misconduct or Abuse
Code
Description
D4
Abusive Conduct Toward Staff
D7
Conduct Evidencing Ethical or Moral Unfitness
71
Conflict of Interest
D5
Disruptive Conduct
16
Misappropriation of Patient Property or Other Property
D2
Non‐Sexual Boundary Violation
14
Patient Abuse
D1
Sexual Misconduct
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Clinical Privileges Actions (continued)
Table 41 - Fraud, Deception, or Misrepresentation
Code
Description
E6
Failure to Disclose
E3
Filing False Reports or Falsifying Records
E4
Fraud, Deceit or Material Omission in Obtaining License or Credentials
55
Improper Billing Practices
E1
Insurance Fraud (Medicare, Medicaid or Other Insurance)
81
Misrepresentation of Credentials
56
Submitting False Claims
Table 42 - Unsafe Practice or Substandard Care
Code
Description
F8
Failure to Consult or Delay in Seeking Consultation With Supervisor/Proctor
FF
Foreign Body Retained Inappropriately in a Patient
F1
Immediate Threat to Public
17
Inadequate or Improper Infection Control Practices
FA
Inappropriate Refusal to Treat
FE
Incorrect Site Procedure
13
Negligence
F9
Patient Abandonment
F6
Substandard Care or Inadequate Skill Level
F2
Unable to Practice Safely by Reason of Substance Use
F4
Unable to Practice Safely by Reason of Physical Impairment
F3
Unable to Practice Safely by Reason of Psychological Impairment
FG
Wrong Patient
Table 43 - Improper Supervision or Allowing Unlicensed Practice
Code
Description
G2
Allowing or Aiding Unlicensed Practice
G1
Improper or Inadequate Supervision or Delegation
Table 44 - I
mproper Prescribing, Dispensing, Administering Medication/Drug Violation
Code
Description
H6
Inappropriate Acquisition or Diversion of Controlled Substance
H5
Error in Prescribing, Dispensing or Administering Medication or Sedation
H1
Drug Violation or Other Violation of Drug Statutes
H4
Inappropriate or Unauthorized Administration of Medication or Sedation
H3
Inappropriate or Unauthorized Dispensing of Medication
H2
Inappropriate or Unauthorized Prescribing of Medication
Table 45 - Other
Code
Description
99
Other - Not Classified, Specify______________
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Exclusion or Debarment Actions
Table 46 - Criminal Conviction
Code
Description
66
Conviction Relating to Controlled Substances
64
Conviction Relating to Fraud
65
Conviction Relating to Obstruction of an Investigation
63
Conviction Relating to Patient Abuse or Neglect
69
Criminal Conviction - Not Classified
61
Felony Conviction Relating to Controlled Substance Violations
60
Felony Conviction Relating to Health Care Fraud
62
Program-Related Conviction
Table 47 - Other
Code
Description
71
Conflict of Interest
72
Corporate Integrity Agreement Breach
44
Default on Health Education Loan or Scholarship Obligations
41
Entities Owned or Controlled by a Sanctioned Individual
40
Exclusion or Suspension From a Federal or State Health Care Program
46
Failure to Grant Immediate Access
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
51
Failure to Perform Contractual Obligations
47
Failure to Take Corrective Action
57
Fraud, Kickbacks or Other Prohibited Activities
54
Furnishing Unnecessary or Substandard Items or Services
58
Imposition of Civil Money Penalty or Assessment
55
Improper Billing Practices
42
Individuals Controlling Sanctioned Entities
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
H1
Drug Violation or Other Violation of Drug Statutes
59
Peer Review Organization Recommendation
73
Settlement Agreement Breach
56
Submitting False Claims
A7
Surrendered License to Practice
A6
Violation of Federal or State Statutes, Regulations or Rules
99
Other - Not Classified, Specify, ___________________
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Federal Licensure, State Licensure or Certifications Actions
Table 48 - Non-Compliance With Requirements
Code
Description
Guidelines
Examples and Explanations
44
Default on Health
Education Loan or
Scholarship
Obligations
Fails to meet health education
loan or scholarship obligations.
Explanation: Use only if your state has this
requirement.
35
Drug Screening
Violation
Fails a drug screening test.
Examples:
• Failure of a required drug screen or failure to
comply with the requested drug screen.
• Sample is adulterated, invalid or substituted.
• Failure of a drug screen for employment.
A2
Failure to Comply
With Continuing
Education or
Competency
Requirements
Fails to meet the continuing
education or competency
requirements for renewal or
reinstatement.
Examples:
• Failure to complete state requirements.
• If the licensee falsified meeting the requirements,
then also use Code E3.
31
Failure to Comply
With Health and
Safety Requirements
or State Health Code
Fails to comply with federal, state,
local or institutional safety
requirements or state health
codes.
Examples:
• Failure to meet required health tests or
inoculations.
DO NOT use for:
• Violation of infection control, sterile technique,
and isolation requirements; instead use Code 17.
23
Failure to Cooperate
With Board
Investigation
Interferes with an investigation or
disciplinary proceeding by
withholding information, deliberate
misrepresentation of facts or
attempts to suppress evidence.
Examples:
• Failure to respond or to respond adequately to
board investigation requests.
• Failure to cooperate with the board as a
witness to an investigation.
50
Failure to Maintain or
Provide Adequate or
Accurate Medical
Records, Financial
Records or Other
Required Information
Fails to meet documentation
requirements for maintaining
patient care, financial or other
records.
Example:
• Failure to provide adequate documentation of
treatment/care in the medical record.
A1
Failure to Meet
Licensure
Requirements /
Licensing Board
Reporting
Requirements
Fails to meet board specified
licensing requirements or provide
requested/ required information.
NOTE: Do not report or include
threshold criteria: the accepted
minimum licensure requirements
that are universally applied without
decision or exception. Examples
include academic degrees,
criminality, certifications, or
training hours or requirements.
Examples:
• Failure to meet board requirements other than
threshold licensure requirements.
• Failure to provide information required by the
board (e.g., criminal conviction, loss of job due to
unprofessional conduct, disciplinary action in
another jurisdiction, change of address etc.).
• Failure to report any renewal and reinstatement
requirements.
• Failure to report another health care professional
as required by mandatory reporting obligations.
DO NOT use for:
• Failure to meet threshold criteria: the accepted
minimum licensure requirements that are
universally applied without decision or exception.
Examples include academic degrees, criminality,
certifications, or training hours or requirements.
• Continuing Competency requirements; instead
use Code A2.
• Obtaining a license but failing to disclose required
information on the application; instead use Code
E4.
37
Failure to Pay or
Delinquent With Child
Support
Fails to meet child support
responsibilities.
Explanation: Use only if your state has this
requirement.
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Code
Description
Guidelines
Examples and Explanations
39
Disciplinary Action
Taken by Another
Federal, State or
Local Licensing
Authority
Grounds for action are based on
action(s) taken by another state
licensing, federal or other
authority.
Examples:
• A licensee is licensed in another jurisdiction and
has final disciplinary action by that authority.
DO NOT use for:
• Your own jurisdiction’s disciplinary action.
29
Practicing Beyond the
Scope of Practice
Provides care not permitted under
the terms of a license or within the
licensee's level of education,
training, knowledge, skills,
experience or demonstrated
competency.
Examples:
• Performing practice interventions, whether
advanced or not, without required license,
certification or training.
• Failure to work with adequate/required
supervision.
DO NOT use for:
• Substandard or Inadequate Care for
incompetence issues; instead use Code F6.
• Negligence for not exercising reasonable
judgement; instead use Code 13.
24
Practicing With an
Expired License
Fails to renew license and
continues to practice.
Example:
• Failure to renew license intentionally or
unintentionally and continues to practice.
DO NOT use for:
• A new graduate who fails the exam and
continues to practice under a temporary license
which expired on getting exam results; instead use
Code A4.
• Someone who has had their license revoked and
continues to practice; instead use Code A4.
A4
Practicing Without a
Valid License
Practices without obtaining the
proper authorization.
Examples:
• Failure to cease practice after a temporary
license or permit has expired.
• Applicant or licensee practices after passing the
exam but before licensing authority has issued
license.
DO NOT use for:
• Someone whose license has expired; instead use
Code 24.
A6
Violation of Federal or
State Statutes,
Regulations or Rules
Violation of federal or state
statutes, regulations or rules not
associated with the practice act.
Examples:
• Failure to meet alimony responsibilities.
• Failure to report abuse or other federal or state
requirement.
DO NOT use for:
• Violations of the state practice act.
• Failure to meet child support; instead use Code
37.
36
Violation of Federal or
State Tax Code
Fails to meet federal or state tax
code responsibilities.
Example:
• Failure to meet federal or state tax code
responsibilities.
Explanation:
• Use with appropriate criminal conviction or
adjudication code if applicable.
A5
Violation of or Failure
to Comply With
Licensing Board
Order
Fails to comply with a specific
board order.
Example:
• Failure to meet terms of a board order.
Table 49 - Criminal Conviction or Adjudication
Code
Description
Guidelines
Examples and Explanations
19
Criminal Conviction
Convicted of a felony or
misdemeanor crime
Example:
• Convicted of a felony or misdemeanor crime
Explanation:
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Code
Description
Guidelines
Examples and Explanations
• Use this code along with the appropriate code to
describe the underlying violation of law.
• If there is no appropriate code, describe the
criminal conviction in the narrative.
18
Deferred Adjudication
Plea that avoids criminal
conviction by meeting certain
probationary requirements.
Explanation:
• Deferred adjudication involves probation,
treatment programs, and/or some type of
community supervision.
• Use this code along with the appropriate code to
describe the underlying violation of law.
• If there is no appropriate code, describe the
violation in the narrative.
B1
Nolo Contendere Plea
Plea of no contest, same
consequence as a guilty plea.
N/A.
I1
Diverted Conviction
Pre‐trial sentencing that avoids
criminal conviction by completing a
court ordered intervention
program.
Explanation:
• Pretrial sentencing includes participating in a
treatment or rehabilitation program.
• Use this code along with the appropriate code to
describe the underlying violation of law.
• If there is no appropriate code, describe the
violation in the narrative.
Table 50 - Confidentiality, Consent or Disclosure Violations
Code
Description
Guidelines
Examples and Explanations
C3
Breach of
Confidentiality
Releases or obtains patient
information without appropriate
Authorization.
Example:
• Releasing or obtaining patient information without
appropriate authorization.
C2
Failure to Comply
With Patient
Consultation
Requirements
Fails to meet requirements for
consultation with other health care
providers or refer when
appropriate.
Examples:
• Failure to consult with or refer to an appropriate
licensee when care is beyond the licensee’s level
of training, skill, expertise or license.
• Failure to keep a referring source informed of the
patient’s progress.
C1
Failure to Obtain
Informed Consent
Fails to meet informed consent
requirements.
Examples:
• Failure to explain procedures and possible
complications.
• Failure to obtain permission of the patient to
evaluate and treat; as well as failure to obtain
parental permission for a minor.
Table 51 - Misconduct or Abuse
Code
Description
Guidelines
Examples and Explanations
D4
Abusive Conduct
Toward Staff
Engages in the maltreatment of a
colleague or employee which can
include mental, physical and/or
verbal abuse.
Example:
• Engaging in the maltreatment of a colleague or
employee (i.e. mental, physical and/or verbal
abuse).
DO NOT use for:
• Sexual abuse; instead use Code D1.
D7
Conduct Evidencing
Ethical or Moral
Unfitness
Engages in conduct that is
unethical or violates the ethical
code of conduct.
Examples:
• Failure to respect the beliefs and values of patient
without prejudice.
• Failure to protect or disregards the rights, health,
safety of the patient.
71
Conflict of Interest
Fails to disclose information that
presents a conflict of interest.
Examples:
• Failure to‐disclose ownership.
• Failure to provide freedom of choice.
D5
Disruptive Conduct
Engages in conduct which
interferes with or disrupts normal
Example:
• Interferes with or disrupts normal operations in the
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Code
Description
Guidelines
Examples and Explanations
operations in the patient care
setting or workplace.
patient care setting or workplace.
DO NOT use for:
• Patient abuse; instead use Code 14.
D3
Exploiting a Patient
for Financial Gain
Exploits a professional relationship
with a patient to benefit financially
beyond that which is reasonable for
the provision of treatment.
Examples:
• Takes advantage of the patient relationship by
selling products that are not needed for treatment or
could be obtained for a lower price.
• Takes advantage of the patient relationship by
inviting them into business opportunities.
DO NOT use for:
• Excessive or fraudulent billing; instead use
Code 55.
16
Misappropriation of
Patient Property or
Other Property
Uses a patient's or coworker's
property or the property of a facility
without approval or permission.
Example:
• Using or taking a patient’s or coworker’s property
or the property of a facility without approval or
permission.
Explanation:
• Also use Code 19 Criminal Conviction if there has
been a criminal conviction.
DO NOT use for:
• Diverting medications from a patient; instead use
Code H6.
D2
Non‐Sexual Boundary
Violation
Engages in a non‐sexual
relationship, behavior or boundary
violation that involves exploitation
or coercion of a patient or former
patient and contains harmful or
potentially harmful elements.
Examples:
• Excessive personal disclosure, secrecy, reversal of
roles or actions that meet the needs of the licensee
(borrowing money).
• Non‐sexual relationship with a patient’s
significant other.
14
Patient Abuse
Engages in the maltreatment of a
patient which can include mental,
physical and/or verbal abuse.
Example:
• Mental, physical and/or verbal abuse of a patient.
DO NOT use for:
• Sexual abuse or sexual assault; instead use Code
D1.
D1
Sexual Misconduct
Engages in behavior that exploits
the practitioner‐patient relationship
in a sexual way, or engages in
workplace sexual harassment such
as unwelcome sexual advances or
conduct of a sexual nature which
interferes with the performance of
another person's job or creates an
intimidating, hostile, or offensive
work environment.
Examples:
• Sexual exploitation of a patient.
• Workplace sexual harassment.
• Sexual assault.
• Sexual abuse.
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Federal Licensure, State Licensure or Certifications Actions (continued)
Table 52 - Fraud, Deception, or Misrepresentation
Code
Description
Guidelines
Examples and Explanations
E6
Failure to Disclose
Fails to disclose information that is
required by the board.
Examples:
• Failure to disclose criminal or disciplinary history
on a license application.
• Failure to disclose revenues generated from
selling equipment or other financial relationships,
etc.
E3
Filing False Reports or
Falsifying Records
Fabricates patient, medical,
health, employee, or other
records.
Examples:
• Failure to provide accurate patient, medical,
health, employee, or other records.
• Documenting treatment that did not occur .
Explanation:
Use this code in conjunction with A2 Failure to
Comply with Continuing Education or Competency
Requirements for falsifying licensee continuing
education or competence records.
DO NOT use for:
• False billing for care/treatment; instead use Code
56.
E4
Fraud, Deceit or
Material Omission in
Obtaining License or
Credentials
Provides false, altered or omits
documents and information when
applying for licensure.
Examples:
• Provides false documentation in licensure
application materials (transcript, letters, etc.).
• Failure to disclose prior disciplinary action or
criminal conviction on application.
• Falsifies testing materials (cheating,
trafficking, etc.).
55
Improper Billing
Practices
Knowingly or intentionally bills
improperly.
Examples:
• Knowingly uses incorrect treatment or billing
codes.
• Charges unreasonable fees.
• Intentionally overbills.
DO NOT use for:
• Conviction of insurance fraud; instead use
Code E1.
E1
Insurance Fraud
(Medicare, Medicaid or
Other Insurance)
Convicted of Medicare, Medicaid
or other insurance fraud,
Examples:
• Convicted of Medicare, Medicaid or other
insurance fraud.
Explanation:
• Use in conjunction with Code 19 Criminal
Conviction.
E5
Misleading, False or
Deceptive Advertising
or Marketing
Uses misleading, false or
deceptive advertising or marketing
related to services, treatment,
procedures or care.
Example:
• False or misleading advertising related to license.
DO NOT use for:
• Failure to correctly identify credentials; instead
use Code 81.
81
Misrepresentation of
Credentials
Fails to properly identify oneself
with regards to education, training,
knowledge, experience, or skills.
Example:
• Failure to properly identify education, training,
knowledge, experience, or skills.
E2
Providing or Ordering
Unnecessary Tests or
Services
Orders or provides unnecessary
tests, procedures, treatment or
services.
Examples:
• Overutilization of tests/services.
• Providing unnecessary treatment.
56
Submitting False
Claims
Requests reimbursement for
services that did not occur or does
not reflect the actual treatment
provided.
Example:
• Intentionally billing for interventions/care that did
not occur.
DO NOT use for:
• Conviction for insurance fraud; instead use Code
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Code
Description
Guidelines
Examples and Explanations
E1.
• Documenting treatments/care that did not occur
or falsifying patient records; instead use Code E3.
Table 53 - Unsafe Practice or Substandard Care
Code
Description
Guidelines
Examples and Explanations
F8
Failure to Consult or
Delay in Seeking
Consultation With
Supervisor/Proctor
Fails to provide or delaying proper
consultation with supervisor or
proctor.
Example:
• Failure to consult with or report to a
supervisor/ordering health care provider/proctor.
FF
Foreign Body
Retained
Inappropriately in a
Patient
Leaves an item(s) inside a patient
after a procedure that should not
be there.
Example:
• Retained foreign body refers to any item or
foreign object related to any operative or invasive
procedure that is left inside a patient. Common
items include sponges and towels; retractors,
unretrieved device components or fragments, parts
of trocars, guidewires, catheters, and pieces of
drains; needles and other sharps.
F1
Immediate Threat to
Public
Presents an immediate risk to
health or safety; Board uses
emergency measures to remove a
practitioner from practice.
Examples:
• Emergency or summary suspension of a license.
Explanation:
• Use in combination with a code that best
describes the violation.
17
Inadequate or
Improper Infection
Control Practices
Fails to conform to recognized
standards or orders for infection
control.
Example:
• Failure to follow policies or procedures for
infection control, sterile technique or isolation
requirements.
DO NOT use for:
• Failure to comply with federal, state, local or
institutional safety requirements or state health
codes; instead use Code 31.
FA
Inappropriate Refusal
to Treat
Refuses to treat a patient due to
religious, moral or other reasons.
Example:
• Refusal to treat a patient due to religious, moral
or other reasons.
FE
Incorrect Site
Procedure
Procedure performed on the
wrong side or site of the body,
wrong surgical procedure
performed.
Example:
• Performing an invasive procedure on wrong side
of the body.
• Performing a non‐invasive procedure on the
wrong side of the body, e.g. taking blood pressure
on the side of an arteriovenous fistula.
13
Negligence
Fails to provide the skill, care
and learning expected of a
reasonably prudent health care
provider.
Example:
• Failure to exercise reasonable judgment.
DO NOT use for:
• Competence issue; instead use Code F6.
F9
Patient Abandonment
Terminates care without adequate
notice for the professional
relationship between a health care
provider and a patient/client at a
time when the patient needs
further care.
Example:
• Deserts or neglects a patient with whom there is
an established provider‐patient relationship without
making reasonable arrangements for the
continuation of care and without reasonable notice.
F6
Substandard Care or
Inadequate Skill Level
Fails to meet clinical standards of
practice, unable to practice
competently or practicing with
insufficient skill.
Example:
• Failure to provide competent care.
DO NOT use for:
• Practicing beyond level of training; instead
use Code 29.
F4
Unable to Practice
Safely by Reason of
Physical Impairment
Unable to practice safely by
reason of physical impairment.
Example:
• Failure/inability to practice safely by reason of
physical impairment.
F3
Unable to Practice
Unable to practice safely by
Example:
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Code
Description
Guidelines
Examples and Explanations
Safely by Reason of
Psychological
Impairment
reason of psychological
impairment.
• Failure/inability to practice safely by reason of
psychological impairment.
F2
Unable to Practice
Safely by Reason of
Substance Use
Unable to practice safely by
reason of substance use.
Example:
• Failure/inability to practice safely by reason of
substance use.
FG
Wrong Patient
Procedure or treatment performed
on the wrong patient.
Example:
• Performing an invasive procedure on the wrong
patient.
• Performing a non‐invasive procedure on the
wrong patient e.g. ambulating the wrong patient.
Table 54 - Improper Supervision or Allowing Unlicensed Practice
Code
Description
Guidelines
Examples and Explanations
G2
Allowing or Aiding
Unlicensed Practice
Allows or assists someone
practice without a license.
Example:
• Knowingly allows unlicensed practice.
G1
Improper or
Inadequate
Supervision or
Delegation
Fails to supervise adequately or
properly those assigned to you.
Example:
• Failing to supervise adequately or properly those
assigned to you.
Table 55 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation
Code
Description
Guidelines
Examples and Explanations
H6
Inappropriate
Acquisition or
Diversion of
Controlled Substance
Diverts prescription medication
from a patient or a healthcare
facility with intent to sell, distribute
or consume for personal misuse.
Example:
• Removing a prescribed medication from a
patient's inventory, unused portion, waste, trash or
healthcare facility inventory for self or someone
other than the patient.
H5
Error in Prescribing,
Dispensing or
Administering
Medication or
Sedation
Makes an error when prescribing,
dispensing, or administering
medications.
Examples:
• Giving medication to the wrong patient.
• Giving the wrong medication.
• Giving medication at the wrong time.
• Giving wrong dosage of medication.
• Giving medication by the wrong route.
• Improper storage of medication.
H1
Drug Violation or
Other Violation of
Drug Statutes
Controlled substance violation
regardless of conviction.
Examples:
• Controlled substance violation regardless of
conviction.
Explanation:
• If there is a conviction, also use Code 19
Criminal Conviction.
H4
Inappropriate or
Unauthorized
Administration of
Medication or
Sedation
Administers medications
improperly or without the
appropriate prescription or
medication order.
Example:
• Failure to administer medications properly or
without the appropriate prescription/order.
H3
Inappropriate or
Unauthorized
Dispensing of
Medication
Dispenses medication improperly
or without the appropriate
authorization.
Example:
• Failure to obtain authorization or prescription to
dispense medication.
H2
Inappropriate or
Unauthorized
Prescribing of
Medication
Improper prescribing or attempting
to prescribe without authority or
altering medication order.
Examples:
• Forging signature on order/prescription.
• Altering an order/prescription.
• Failure to obtain prescriber authorization or
signature.
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Table 56 - Other
Code
Description
Guidelines
Examples and Explanations
99
Other - Not Classified,
Specify, ____________
Use only if no other code is
applicable.
N/A.
Government Administrative Actions
Table 57 - Non-Compliance With Requirements
Code
Description
A8
Clinical Privileges Restricted, Suspended or Revoked by Another Hospital or Health Care Facility
82
Debarment from Federal or State Program
44
Default on Health Education Loan or Scholarship Obligations
43
Employing or Contracting With Individuals or Entities Excluded From a Federal or State Health Care Program
40
Exclusion or Suspension From a Federal or State Health Care Program
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
51
Failure to Perform Contractual Obligations
21
Failure to Repay Overpayment
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
24
Practicing With an Expired License
A4
Practicing Without a Valid License
A7
Surrendered License to Practice
A6
Violation of Federal or State Statutes, Regulations or Rules
A5
Violation of or Failure to Comply With Licensing Board Order
Table 58 - Criminal Conviction or Adjudication
Code
Description
19
Criminal Conviction
18
Deferred Adjudication
B1
Nolo Contendere Plea
Table 59 - Confidentiality, Consent or Disclosure Violations
Code
Description
C3
Breach of Confidentiality
C2
Failure to Comply With Patient Consultation Requirements
C1
Failure to Obtain Informed Consent
Table 60 - Misconduct or Abuse
Code
Description
D4
Abusive Conduct Toward Staff
D7
Conduct Evidencing Ethical or Moral Unfitness
71
Conflict of Interest
D5
Disruptive Conduct
16
Misappropriation of Patient Property or Other Property
D2
Non‐Sexual Boundary Violation
14
Patient Abuse
D1
Sexual Misconduct
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Government Administrative Actions (continued)
Table 61 - Fraud, Deception, or Misrepresentation
Code
Description
E6
Failure to Disclose
E3
Filing False Reports or Falsifying Records
E4
Fraud, Deceit or Material Omission in Obtaining License or Credentials
55
Improper Billing Practices
E1
Insurance Fraud (Medicare, Medicaid or Other Insurance)
E5
Misleading, False or Deceptive Advertising or Marketing
81
Misrepresentation of Credentials
E2
Providing or Ordering Unnecessary Tests or Services
56
Submitting False Claims
Table 62 - Unsafe Practice or Substandard Care
Code
Description
F8
Failure to Consult or Delay in Seeking Consultation With Supervisor/Proctor
FF
Foreign Body Retained Inappropriately in a Patient
F1
Immediate Threat to Public
17
Inadequate or Improper Infection Control Practices
FA
Inappropriate Refusal to Treat
FE
Incorrect Site Procedure
13
Negligence
F9
Patient Abandonment
F6
Substandard Care or Inadequate Skill Level
F2
Unable to Practice Safely by Reason of Substance Use
F4
Unable to Practice Safely by Reason of Physical Impairment
F3
Unable to Practice Safely by Reason of Psychological Impairment
FG
Wrong Patient
Table 63 - Improper Supervision or Allowing Unlicensed Practice
Code
Description
G2
Allowing or Aiding Unlicensed Practice
G1
Improper or Inadequate Supervision or Delegation
Table 64 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation
Code
Description
H6
Inappropriate Acquisition or Diversion of Controlled Substance
H5
Error in Prescribing, Dispensing or Administering Medication or Sedation
H1
Drug Violation or Other Violation of Drug Statutes
H4
Inappropriate or Unauthorized Administration of Medication or Sedation
H3
Inappropriate or Unauthorized Dispensing of Medication
H2
Inappropriate or Unauthorized Prescribing of Medication
Table 65 - Other
Code
Description
99
Other - Not Classified, Specify, ___________________
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Health Plan Actions
Table 66 - Non-Compliance With Requirements
Code
Description
A8
Clinical Privileges Restricted, Suspended or Revoked by Another Hospital or Health Care Facility
82
Debarment From Federal or State Program
43
Employing or Contracting With Individuals or Entities Excluded From a Federal or State Health Care Program
40
Exclusion or Suspension From a Federal or State Health Care Program
AA
Failure to Comply With Corrective Action Plan
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
A9
Failure to Meet or Comply With Contractual Obligations, Participation Requirements, or Credentialing Standards
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
29
Practicing Beyond the Scope of Practice
24
Practicing With an Expired License
A4
Practicing Without a Valid License
A7
Surrendered License to Practice
Table 67 - Criminal Conviction or Adjudication
Code
Description
19
Criminal Conviction
18
Deferred Adjudication
B1
Nolo Contendere Plea
Table 68 - Confidentiality, Consent or Disclosure Violations
Code
Description
C3
Breach of Confidentiality
C2
Failure to Comply With Patient Consultation Requirements
C1
Failure to Obtain Informed Consent
Table 69 - Misconduct or Abuse
Code
Description
D4
Abusive Conduct Toward Staff
D7
Conduct Evidencing Ethical or Moral Unfitness
71
Conflict of Interest
D5
Disruptive Conduct
16
Misappropriation of Patient Property or Other Property
D2
Non‐Sexual Boundary Violation
14
Patient Abuse
D1
Sexual Misconduct
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Health Plan Actions (continued)
Table 70 - Fraud, Deception, or Misrepresentation
Code
Description
E6
Failure to Disclose
E3
Filing False Reports or Falsifying Records
E4
Fraud, Deceit or Material Omission in Obtaining License or Credentials
55
Improper Billing Practices
E1
Insurance Fraud (Medicare, Medicaid or Other Insurance)
E5
Misleading, False or Deceptive Advertising or Marketing
81
Misrepresentation of Credentials
E2
Providing or Ordering Unnecessary Tests or Services
56
Submitting False Claims
Table 71 - Unsafe Practice or Substandard Care
Code
Description
FB
Excessive Malpractice Cases/Extensive Malpractice History
F8
Failure to Consult or Delay in Seeking Consultation With Supervisor/Proctor
FF
Foreign Body Retained Inappropriately in a Patient
F1
Immediate Threat to Public
17
Inadequate or Improper Infection Control Practices
FA
Inappropriate Refusal to Treat
FE
Incorrect Site Procedure
13
Negligence
F9
Patient Abandonment
F6
Substandard Care or Inadequate Skill Level
F2
Unable to Practice Safely by Reason of Substance Use
F4
Unable to Practice Safely by Reason of Physical Impairment
F3
Unable to Practice Safely by Reason of Psychological Impairment
FG
Wrong Patient
Table 72 - Improper Supervision or Allowing Unlicensed Practice
Code
Description
G2
Allowing or Aiding Unlicensed Practice
G1
Improper or Inadequate Supervision or Delegation
Table 73 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation
Code
Description
H6
Inappropriate Acquisition or Diversion of Controlled Substance
H5
Error in Prescribing, Dispensing or Administering Medication or Sedation
H1
Drug Violation or Other Violation of Drug Statutes
H4
Inappropriate or Unauthorized Administration of Medication or Sedation
H3
Inappropriate or Unauthorized Dispensing of Medication
H2
Inappropriate or Unauthorized Prescribing of Medication
Table 74 - Other
Code
Description
99
Other - Not Classified, Specify, ___________________
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Professional Society Actions
Table 75 - Non-Compliance With Requirements
Code
Description
A8
Clinical Privileges Restricted, Suspended or Revoked by Another Hospital or Health Care Facility
AA
Failure to Comply With Corrective Action Plan
AH
Failure to Comply With Terms of Probation or other Previously Imposed Requirements
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
29
Practicing Beyond the Scope of Practice
AB
Practicing Beyond the Scope of Privileges
24
Practicing With an Expired License
A4
Practicing Without a Valid License
A7
Surrendered License to Practice
70
Violation of By-Laws, Protocols or Guidelines
79
Violation of Code of Ethics
Table 76 - Criminal Conviction or Adjudication
Code
Description
19
Criminal Conviction
18
Deferred Adjudication
B1
Nolo Contendere Plea
Table 77 - Confidentiality, Consent or Disclosure Violations
Code
Description
C3
Breach of Confidentiality
C2
Failure to Comply With Patient Consultation Requirements
C1
Failure to Obtain Informed Consent
Table 78 - Misconduct or Abuse
Code
Description
D4
Abusive Conduct Toward Staff
D7
Conduct Evidencing Ethical or Moral Unfitness
71
Conflict of Interest
D5
Disruptive Conduct
16
Misappropriation of Patient Property or Other Property
D2
Non‐Sexual Boundary Violation
14
Patient Abuse
D1
Sexual Misconduct
Table 79 - Fraud, Deception, or Misrepresentation
Code
Description
E6
Failure to Disclose
E3
Filing False Reports or Falsifying Records
E4
Fraud, Deceit or Material Omission in Obtaining License or Credentials
55
Improper Billing Practices
E1
Insurance Fraud (Medicare, Medicaid or Other Insurance)
81
Misrepresentation of Credentials
56
Submitting False Claims
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Table 80 - Unsafe Practice or Substandard Care
Code
Description
F8
Failure to Consult or Delay in Seeking Consultation With Supervisor/Proctor
FF
Foreign Body Retained Inappropriately in a Patient
F1
Immediate Threat to Public
17
Inadequate or Improper Infection Control Practices
FA
Inappropriate Refusal to Treat
FE
Incorrect Site Procedure
13
Negligence
F9
Patient Abandonment
F6
Substandard Care or Inadequate Skill Level
F2
Unable to Practice Safely by Reason of Substance Use
F4
Unable to Practice Safely by Reason of Physical Impairment
F3
Unable to Practice Safely by Reason of Psychological Impairment
FG
Wrong Patient
Table 81 - Improper Supervision or Allowing Unlicensed Practice
Code
Description
G2
Allowing or Aiding Unlicensed Practice
G1
Improper or Inadequate Supervision or Delegation
Table 82 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation
Code
Description
H6
Inappropriate Acquisition or Diversion of Controlled Substance
H5
Error in Prescribing, Dispensing or Administering Medication or Sedation
H1
Drug Violation or Other Violation of Drug Statutes
H4
Inappropriate or Unauthorized Administration of Medication or Sedation
H3
Inappropriate or Unauthorized Dispensing of Medication
H2
Inappropriate or Unauthorized Prescribing of Medication
Table 83 - Other
Code
Description
99
Other - Not Classified, Specify, ___________________
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AAR Basis for Action Codes - Organization Subjects
Accreditation Actions
Table 84 - Non-Compliance With Federal, State or Contractual Requirements
Code
Description
92
Noncompliance With Private Accreditation Standards That Indicate a Risk to the Safety of Patients or Quality of
Health Care Services
Table 85 - Other
Code
Description
99
Other - Not Classified, Specify, ___________________
Exclusion or Debarment Actions
Table 86 - Criminal Conviction
Code
Description
66
Conviction Relating to Controlled Substances
64
Conviction Relating to Fraud
65
Conviction Relating to Obstruction of an Investigation
63
Conviction Relating to Patient Abuse or Neglect
69
Criminal Conviction - Not Classified
61
Felony Conviction Relating to Controlled Substance Violations
60
Felony Conviction Relating to Health Care Fraud
62
Program-Related Conviction
Table 87 - Other
Code
Description
71
Conflict of Interest
72
Corporate Integrity Agreement Breach
44
Default on Health Education Loan or Scholarship Obligations
41
Entities Owned or Controlled by a Sanctioned Individual
40
Exclusion or Suspension From a Federal or State Health Care Program
46
Failure to Grant Immediate Access
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
51
Failure to Perform Contractual Obligations
47
Failure to Take Corrective Action
57
Fraud, Kickbacks or Other Prohibited Activities
54
Furnishing Unnecessary or Substandard Items or Services
58
Imposition of Civil Money Penalty or Assessment
55
Improper Billing Practices
42
Individuals Controlling Sanctioned Entities
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
H1
Drug Violation or Other Violation of Drug Statutes
59
Peer Review Organization Recommendation
73
Settlement Agreement Breach
56
Submitting False Claims
A7
Surrendered License to Practice
A6
Violation of Federal or State Statutes, Regulations or Rules
99
Other - Not Classified, Specify, ___________________
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Federal Licensure, State Licensure or Certifications Actions
Table 88 - Non-Compliance With Requirements
Code
Description
40
Exclusion or Suspension From a Federal or State Health Care Program
31
Failure to Comply With Health and Safety Requirements or State Health Code
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
AC
Failure to Maintain Equipment/Missing or Inadequate Equipment
AG
Failure to Maintain Supplies/Missing or Inadequate Supplies
A1
Failure to Meet Licensure Requirements / Licensing Board Reporting Requirements
47
Failure to Take Corrective Action
34
Financial Insolvency
32
Lack of Appropriately Qualified Professionals
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
AF
Operating Beyond Scope of License
AE
Operating Without a License or Permits or on a Lapsed License
A6
Violation of Federal or State Statutes, Regulations or Rules
A5
Violation of or Failure to Comply With Licensing Board Order
Table 89 - Criminal Conviction or Adjudication
Code
Description
19
Criminal Conviction
18
Deferred Adjudication
B1
Nolo Contendere Plea
I1
Diverted Conviction
Table 90 - Confidentiality, Consent or Disclosure Violations
Code
Description
C3
Breach of Confidentiality
C2
Failure to Comply With Patient Consultation Requirements
C1
Failure to Obtain Informed Consent
Table 91 - Conflict of Interest
Code
Description
71
Conflict of Interest
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Federal Licensure, State Licensure or Certifications (continued)
Table 92 - Fraud, Deception, or Misrepresentation
Code
Description
E6
Failure to Disclose
E3
Filing False Reports or Falsifying Records
E4
Fraud, Deceit or Material Omission in Obtaining License or Credentials
57
Fraud, Kickbacks or Prohibited Activities
55
Improper Billing Practices
E1
Insurance Fraud (Medicare, Medicaid or Other Insurance)
E5
Misleading, False or Deceptive Advertising or Marketing
E2
Providing or Ordering Unnecessary Tests or Services
56
Submitting False Claims
Table 93 - Substandard Care or Patient Neglect/Abuse
Code
Description
17
Inadequate or Improper Infection Control Practices
FA
Inappropriate Refusal to Treat
F9
Patient Abandonment
14
Patient Abuse
F6
Substandard Care or Inadequate Skill Level
Table 94 - Improper Supervision or Allowing Unlicensed Practice
Code
Description
G2
Allowing or Aiding Unlicensed Practice
G1
Improper or Inadequate Supervision or Delegation
Table 95 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation
Code
Description
H5
Error in Prescribing, Dispensing or Administering Medication or Sedation
H8
Expired Drugs in Inventory
H7
Inadequate Security for Controlled Substances
H9
Misbranding Drug Labels/Lack of Required Labeling on Drugs
H1
Drug Violation or Other Violation of Drug Statutes
H4
Inappropriate or Unauthorized Administration of Medication or Sedation
H3
Inappropriate or Unauthorized Dispensing of Medication
H2
Inappropriate or Unauthorized Prescribing of Medication
Table 96 - Other
Code
Description
99
Other - Not Classified, Specify, ___________________
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Government Administrative Actions
Table 97 - Non-Compliance With Requirements
Code
Description
82
Debarment From Federal or State Program
43
Employing or Contracting With Individuals or Entities Excluded From a Federal or State Health Care Program
40
Exclusion or Suspension From a Federal or State Health Care Program
31
Failure to Comply With Health and Safety Requirements or State Health Code
49
Failure to Comply With the Composition of Enrollment Requirements
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
AC
Failure to Maintain Equipment/Missing or Inadequate Equipment
48
Failure to Obtain a Surety Bond
51
Failure to Perform Contractual Obligations
21
Failure to Repay Overpayment
47
Failure to Take Corrective Action
34
Financial Insolvency
32
Lack of Appropriately Qualified Professionals
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
A6
Violation of Federal or State Statutes, Regulations or Rules
Table 98 - Criminal Conviction or Adjudication
Code
Description
19
Criminal Conviction
18
Deferred Adjudication
B1
Nolo Contendere Plea
Table 99 - Confidentiality, Consent or Disclosure Violations
Code
Description
C3
Breach of Confidentiality
C2
Failure to Comply With Patient Consultation Requirements
C1
Failure to Obtain Informed Consent
Table 100 - Conflict of Interest
Code
Description
71
Conflict of Interest
Table 101 - Fraud, Deception, or Misrepresentation
Code
Description
E6
Failure to Disclose
E3
Filing False Reports or Falsifying Records
E4
Fraud, Deceit or Material Omission in Obtaining License or Credentials
55
Improper Billing Practices
E1
Insurance Fraud (Medicare, Medicaid or Other Insurance)
E5
Misleading, False or Deceptive Advertising or Marketing
E2
Providing or Ordering Unnecessary Tests or Services
56
Submitting False Claims
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Government Administrative Actions (continued)
Table 102 - Substandard Care or Patient Neglect/Abuse
Code
Description
17
Inadequate or Improper Infection Control Practices
FA
Inappropriate Refusal to Treat
FC
Negligent Credentialing
F9
Patient Abandonment
14
Patient Abuse
F6
Substandard Care or Inadequate Skill Level
Table 103 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation
Code
Description
H5
Error in Prescribing, Dispensing or Administering Medication or Sedation
H1
Drug Violation or Other Violation of Drug Statutes
H4
Inappropriate or Unauthorized Administration of Medication or Sedation
H3
Inappropriate or Unauthorized Dispensing of Medication
H2
Inappropriate or Unauthorized Prescribing of Medication
Table 104 - Other
Code
Description
99
Other - Not Classified, Specify, ___________________
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Health Plan Actions
Table 105 - Non-Compliance With Requirements
Code
Description
82
Debarment From Federal or State Program
43
Employing or Contracting With Individuals or Entities Excluded From a Federal or State Health Care Program
40
Exclusion or Suspension From a Federal or State Health Care Program
31
Failure to Comply With Health and Safety Requirements or State Health Code
50
Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required
Information
AC
Failure to Maintain Equipment/Missing or Inadequate Equipment
51
Failure to Perform Contractual Obligations
47
Failure to Take Corrective Action
34
Financial Insolvency
32
Lack of Appropriately Qualified Professionals
39
Disciplinary Action Taken by Another Federal, State or Local Licensing Authority
A6
Violation of Federal or State Statutes, Regulations or Rules
Table 106 - Criminal Conviction or Adjudication
Code
Description
19
Criminal Conviction
18
Deferred Adjudication
B1
Nolo Contendere Plea
Table 107 - Confidentiality, Consent or Disclosure Violations
Code
Description
C3
Breach of Confidentiality
C2
Failure to Comply With Patient Consultation Requirements
C1
Failure to Obtain Informed Consent
Table 108 - Conflict of Interest
Code
Description
71
Conflict of Interest
Table 109 - Fraud, Deception or Misrepresentation
Code
Description
E6
Failure to Disclose
E3
Filing False Reports or Falsifying Records
E4
Fraud, Deceit or Material Omission in Obtaining License or Credentials
55
Improper Billing Practices
E1
Insurance Fraud (Medicare, Medicaid or Other Insurance)
E5
Misleading, False or Deceptive Advertising or Marketing
E2
Providing or Ordering Unnecessary Tests or Services
56
Submitting False Claims
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Health Plan Actions (continued)
Table 110 - Substandard Care or Patient Neglect/Abuse
Code
Description
17
Inadequate or Improper Infection Control Practices
FA
Inappropriate Refusal to Treat
FC
Negligent Credentialing
F9
Patient Abandonment
14
Patient Abuse
F6
Substandard Care or Inadequate Skill Level
Table 111 - Improper Prescribing, Dispensing, Administering Medication/Drug Violation
Code
Description
H5
Error in Prescribing, Dispensing or Administering Medication or Sedation
H1
Drug Violation or Other Violation of Drug Statutes
H4
Inappropriate or Unauthorized Administration of Medication or Sedation
H3
Inappropriate or Unauthorized Dispensing of Medication
H2
Inappropriate or Unauthorized Prescribing of Medication
Table 112 - Other
Code
Description
99
Other - Not Classified, Specify, ___________________
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AAR Basis for Action Codes - Retired
Table 113 - AAR Basis for Action Codes - Retired
Code
Description
22
Advertising or Marketing Services or Products That Are Discriminatory, Misleading, False, or
Deceptive
01
Alcohol and/or Other Substance Abuse
30
Allowing Unlicensed Person to Practice
D6
Conduct Evidencing Moral Unfitness
45
Failure to Maintain Records or Provide Medical, Financial or Other Required Information
A3
Failure to Meet Licensing Board Reporting Requirements
53
Failure to Provide Medically Reasonable and/or Necessary Items or Services
52
Failure to Repay Overpayment
05
Fraud ‐ Unspecified
09
Fraud in Obtaining License or Credentials
83
Hospital Privileges Restricted, Suspended or Revoked
11
Incompetence
06
Insurance Fraud - Medicare or Other Federal Government Program
07
Insurance Fraud - Medicaid or Other State Government Program
08
Insurance Fraud - Non-Government or Private Insurance
12
Malpractice
20
Mental Disorder
03
Narcotics Violations
D8
Other Unprofessional Conduct, Specify
15
Patient Neglect
80
Physical Impairment
25
Practicing Without a License
F7
Substandard or Inadequate Skill Level
AD
Surrendered Clinical Privileges
F5
Unable to Practice Safely
10
Unprofessional Conduct
77
Violation of Americans With Disabilities Act or Applicable Federal and State Laws
78
Violation of Civil Rights Act or Applicable Federal and State Laws
75
Violation of Drug-Free Workplace Act
74
Violation of Federal or State Antitrust Statute
76
Violation of Immigration and Nationality Act Employment Provisions
84
Violation of State Health Code
91
Noncompliance With Private Accreditation Standards
Retired codes are not available for submission on new reports but may appear on existing reports.
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AAR Basis for Finding Codes - Individual Subjects
Peer Review Organization
Table 114 - Fraud, Deception or Misrepresentation
Code
Description
55
Improper Billing Practices
56
Submitting False Claims
Table 115 - Unsafe Practice or Substandard Care
Code
Description
53
Failure to Provide Medically Reasonable and/or Necessary Items or Services
54
Furnishing Unnecessary or Substandard Items or Services
Table 116 - Other
Code
Description
99
Other - Not Classified, Specify, ___________________
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AAR Type of Action Codes
Table 117 - AAR Type of Action Codes
Code Type Description
1 (SL)
Licensure (State
Licensure or
Certification)
State Licensure or Certification actions are adverse actions taken by State
licensing and certification authorities related to the license, certification, or
registration of health care practitioners, providers, and suppliers. State
licensing actions include State professional and health care facility licensing
sanctions. State licensing actions against physicians and dentists that are
based upon the subject's professional competence or conduct are
reportable to the NPDB under provisions of Title IV of the Health Care
Quality Improvement Act of 1986, as amended, and 45 CFR Part 60.
Section 1921 of the Social Security Act 45 CFR Part 60, expands the
reporting requirements of the NPDB to include all licensure actions taken
against all healthcare practitioners, as well as healthcare entities: not just
physicians and dentists. All State licensing actions against health care
practitioners, providers, and suppliers are reportable to the NPDB under
Section 1128E of the Social Security Act and 45 CFR Part 60.
2 (FL) Licensure (Federal
Licensure)
Federal licensure actions are adverse actions taken by Federal licensing
and certification authorities related to the license, certification, or
registration of health care providers, practitioners, and suppliers. Federal
licensure actions include Federal CLIA certification actions; Federal DEA
registration actions; and Federal FDA licensing, certification, and
registration actions. These actions are reportable to the NPDB under
Section 1128E of the Social Security Act and 45 CFR Part 60. DEA
registration actions against health care practitioners also are reportable to
the NPDB under Title IV of the Health Care Quality Improvement Act of
1986, as amended, and 45 CFR Part 60.
3 (CP)
Clinical Privilege
(Includes Panel
Membership)
Clinical Privilege actions are adverse actions taken by hospitals and other
health care entities related to the authorization of health care practitioners
to provide health care services, including actions related to a practitioner's
membership on the medical staff or panel, and based upon the subject's
professional competence or conduct. These actions are reportable to the
NPDB under Title IV of the Health Care Quality Improvement Act of 1986,
as amended, and 45 CFR Part 60.
4 (HP) Health Plan
Health plan actions are adverse actions that are taken by a health plan
against a health care practitioner, provider or supplier and that are
reportable to the NPDB under Section 1128E of the Social Security Act and
45 CFR part 60. These actions must meet the regulatory definition of "other
adjudicated actions," which requires that they: 1) be formal or official
actions; 2) include the availability of a due process mechanism; and 3) be
based on acts or omissions that affect or could affect the payment,
provision or delivery of a health care item or service. The definition
specifically excludes clinical privileging actions or paneling decisions (which
normally are the result of a formal peer review process). However, quality
actions that include the availability of due process are reportable. An
example of a reportable health plan action would be the termination of a
practitioner's contract to provide health care services, as long as it meets
the three specified criteria.
Code Lists Version 2.10
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Code Type Description
5 (ED) Exclusion or
Debarment
The exclusion or debarment of a health care practitioner, provider, or
supplier from participating in and/or contracting with a Federal or State
health care program is reportable to the NPDB under Section 1128E of the
Social Security Act and 45 CFR Part 60. Exclusion of a practitioner from the
Medicare and Medicaid programs is reportable to the NPDB under a
Memorandum of Understanding with the Office of Inspector General, and
the Centers for Medicare & Medicaid Services, U.S. Department of Health
and Human Services.
6 (PS) Professional Society
Professional Society actions are adverse actions taken by associations of
health care practitioners that follow formal peer review processes for the
purpose of furthering quality health care and that are based upon the
subject's professional competence or conduct. These actions are reportable
to the NPDB under the provisions of Title IV of the Health Care Quality
Improvement Act of 1986, as amended, and 45 CFR Part 60.
7 (PR) Peer Review
Organization
Peer review organization actions include any recommendation by a peer
review organization to sanction a health care practitioner. These actions
are reportable to the NPDB under the provisions of Section 1921 of the
Social Security Act and 45 CFR Part 60
.
8 (AC) Accreditation Private accreditation organization actions include final determinations of
denial or termination of an accreditation status from a private accreditation
entity that indicates a risk to the safety of a patient(s) or quality of health
care services. These actions are taken against health care entities that
have received or are attempting to receive accreditation. These actions are
reportable to the NPDB under the provisions of 45 CFR Part 60.
9 (GA) Government
Administrative
Government Administrative actions are reportable to the NPDB under
Section 1921 of the Social Security Act, and Section 1128E of the Social
Security Act and 45 CFR Part 60. State actions are reportable under
Section 1921 of the Social Security Act and Federal actions are reportable
under Section 1128E of the Social Security Act. They encompass adverse
actions reportable to NPDB that are not classified elsewhere. This category
includes any publicly available negative action or finding by Government
agencies (Federal or State) that certify health care practitioners, providers,
and suppliers for participation in a Government health care program. In
addition, other Government Administrative actions include any other
adjudicated action or decision by an authorized Government agency
(Federal or State) against a health care practitioner, provider, or supplier.
These adjudicated actions or decisions may include, for example, personnel
actions, employment disqualifications, and contract terminations.
AAR Type of Action Codes (Old Format)
Table 118 - AAR Type of Action Codes (Old Format)
Code Type
L Licensure
C Clinical Privileges
S Society Membership
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AAR Automatic Reinstatement Codes
Table 119 - AAR Automatic Reinstatement Codes
Code Description
Y Reinstatement is automatic at completion of adverse action period.
N Reinstatement is not automatic.
C Reinstatement is automatic, with conditions.
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Nature of Relationship Codes
Individual Subjects
Table 120 - Individual Subjects
Code
Description
100
Subject is Owner/Partner of Affiliate or Associate
150
Subject is Manager/Supervisor/Director of Affiliate or Associate
200
Subject is Employee of Affiliate or Associate
250
Subject is Contractor to Affiliate or Associate
300
Subject is Member of Affiliate or Associate’s Network
350
Subject has Clinical Privileges With Affiliate or Associate
400
Subject is Supplier to Affiliate or Associate
450
Subject is Customer of Affiliate or Associate
700
Subject is in Joint Venture With Affiliate or Associate
999
Other Relationship - Not Classified, Specify, ____________________
Organization Subjects
Table 121 - Organization Subjects
Code
Description
250
Subject is Contractor to Affiliate or Associate
300
Subject is Member of Affiliate or Associate’s Network
400
Subject is Supplier to Affiliate or Associate
450
Subject is Customer of Affiliate or Associate
500
Subject is Parent Organization of Affiliate or Associate
600
Subject is Subsidiary of Affiliate or Associate
700
Subject is in Joint Venture With Affiliate or Associate
999
Other Relationship - Not Classified, Specify, ____________________
Code Lists Version 2.10
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JOCR Act or Omission Codes
Table 122 - JOCR Act or Omission Codes
Code
Description
200
Fraudulent Billing/Cost Reporting
205
Billing for Services Not Rendered/Supplies Not Provided
207
Misrepresentation of Services/ Supplies Provided
210
Duplicate Billing
220
Unbundling of Services
222
Upcoding of Services
230
Fraudulent Cost Reporting
240
Medicare/Medicaid Secondary Payor Fraud
250
Submitting Claims After Sanctions
260
Overcharging
270
Failure to Pay Non-Assigned Claim
300
Patient Abuse
305
Theft or Misappropriation of Patient Property
310
Billing for Medically Unnecessary Services
320
Poor Quality of Care
350
Failure to Provide Medically Necessary Care
400
Licensed Practitioner Impersonation/ Allowing Unlicensed Persons to Practice
500
Procurement Fraud
525
Research Fraud
550
Medical Record Falsification
551
Creating Medical Record for Patient Who Does Not Exist
552
Alteration/Misrepresentation of Medical Record
600
Anti-Competition Violation/Deceptive Advertising
700
Controlled Substances Violation
710
Mislabeling Drugs
720
Generic Substitutions
730
Prescription Splitting
735
Prescription Shorting
740
Drug Diversion
750
Forged/Altered Prescription Drugs
760
Illegal Prescription of Controlled Substance
770
Counterfeiting Drugs
780
Illegal Drug Use/Possession
790
Illegal Drug Trafficking
810
Kickbacks
820
Self-Referral Violations
999
Other Act/Omission - Not Classified, Specify, ___________________
Code Lists Version 2.10
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JOCR Type of Action Codes
Table 123 - JOCR Type of Action Codes
Code
Type
Description
10
Criminal Conviction
(Guilty Plea or Trial)
Federal or State criminal convictions against health care
practitioners, providers, and suppliers. Convictions must be
related to the delivery of a health care item or service.
Convictions include guilty pleas and findings of guilt by either
a judge or a jury. These actions are reportable to the HIPDB
under Section 1128E of the Social Security Act and 45 CFR
Part 61.
20
Deferred Conviction/Pre-
Trial Diversion
Federal or State court actions in which a healthcare
practitioner, provider, or supplier has entered into participation
in a first offender, or other program or arrangement where the
conviction has been deferred or held in abeyance. These
actions must be related to the delivery of a health care item or
service. These actions are reportable to the HIPDB under
Section 1128E of the Social Security Act and 45 CFR Part 61.
30
Nolo Contendere (No
Contest) Plea
Acceptance by a Federal or State court of a nolo contendere or
no contest plea by a health care practitioner, provider, or
supplier in a matter related to the delivery of a health care item
or service. These actions are reportable to the HIPDB under
Section 1128E of the Social Security Act and 45 CFR Part 61.
40
Civil Judgment
Civil judgments against health care practitioners, providers,
and suppliers in Federal or State courts. Judgments must be
related to the delivery of a health care item or service. This
reporting requirement does not include settlements in which no
findings of liability have been made. These actions are
reportable to the HIPDB under Section 1128E of the Social
Security Act and 45 CFR Part 61.
50
Injunction
Civil actions taken against health care practitioners, providers,
and suppliers that seek to stop a specific activity, such as the
continued production or distribution of a violative product or the
provision of a service. The action must be related to the
delivery of a health care item or service. These actions are
reportable to the HIPDB under Section 1128E of the Social
Security Act and 45 CFR Part 61.
JOCR Jurisdiction Codes
Table 124 - JOCR Jurisdiction Codes
Code
Type
S
State/Local Court
F
Federal Court
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MMPR Act or Omission Codes (Old Format MMPR)
(For Initial Reports submitted through January 30, 2004 using an earlier reporting format)
1
Table 125 - Diagnosis
Code
Description
010
Failure to Diagnose (i.e., Concluding That Patient
Has No Disease or Condition Worthy of Follow-Up or
Observation)
020
Wrong Diagnosis or Misdiagnosis (i.e., Original
Diagnosis is Incorrect)
030
Improper Performance of Test
040
Unnecessary Diagnostic Test
050
Delay in Diagnosis
060
Failure to Obtain Consent/Lack of Informed Consent
090
Diagnosis Related-Not Otherwise Classified
Table 126 - Anesthesia
Code
Description
110
Failure to Complete Patient Assessment
120
Failure to Monitor
130
Failure to Test Equipment
140
Improper Choice of Anesthesia Agent or Equipment
150
Improper Technique/Induction
160
Improper Equipment Use
170
Improper Intubation
180
Improper Positioning
185
Failure to Obtain Consent/Lack of Informed Consent
190
Anesthesia Related-Not Otherwise Classified
Table 127 - Surgery
Code
Description
210
Failure to Perform Surgery
220
Improper Positioning
230
Retained Foreign Body
240
Wrong Body Part
250
Improper Performance of Surgery
260
Unnecessary Surgery
270
Delay in Surgery
280
Improper Management of Surgical Patient
285
Failure to Obtain Consent/Lack of Informed Consent
290
Surgery Related-Not Otherwise Classified
Table 128 - Medication
Code
Description
305
Failure to Order Appropriate Medication
310
Wrong Medication Ordered
315
Wrong Dosage Ordered of Correct Medication
320
Failure to Instruct on Medication
325
Improper Management of Medication Regimen
330
Failure to Obtain Consent/Lack of Informed Consent
340
Medication Error-Not Otherwise Classified
350
Failure to Medicate
355
Wrong Medication Administered
360
Wrong Dosage Administered
365
Wrong Patient
370
Wrong Route
380
Improper Technique
390
Medication Administration Related-Not Otherwise
Classified
Table 129 - Intravenous and Blood Products
Code
Description
410
Failure to Monitor
420
Wrong Solution
430
Improper Performance
440
IV Related-Not Otherwise Classified
450
Failure to Ensure Contamination Free
460
Wrong Type
470
Improper Administration
480
Failure to Obtain Consent/Lack of Informed Consent
490
Blood Product Related-Not Otherwise Classified
Table 130 - Obstetrics
Code
Description
505
Failure to Manage Pregnancy
510
Improper Choice of Delivery Method
520
Improperly Performed Vaginal Delivery
525
Improperly Performed C-Section
530
Delay in Delivery (Induction or Surgery)
540
Failure to Obtain Consent/Lack of Informed Consent
550
Improperly Managed Labor-Not Otherwise Classified
555
Failure to Identify/Treat Fetal Distress
560
Delay in Treatment of Fetal Distress (i.e., Identified
but Treated in Untimely Manner)
570
Retained Foreign Body/Vaginal/Uterine
575
Abandonment
580
Wrongful Life/Birth
590
Obstetrics Related-Not Otherwise Classified
Table 131 - Treatment
Code
Description
610
Failure to Treat
620
Wrong Treatment/Procedure Performed
630
Failure to Instruct Patient on Self-Care
640
Improper Performance of Treatment/Procedure
650
Improper Management of Course of Treatment
660
Unnecessary Treatment
665
Delay in Treatment
670
Premature End of Treatment (Also Abandonment)
675
Failure to Supervise Treatment/Procedure
680
Failure to Obtain Consent/Lack of Informed Consent
685
Failure to Refer or Seek Consultation
690
Treatment Related-Not Otherwise Classified
Table 132 - Monitoring
Code
Description
710
Failure to Monitor
720
Failure to Respond to Patient
730
Failure to Report on Patient Condition
790
Monitoring Related-Not Otherwise Classified
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Table 133 - Biomedical Equipment/Product
Code
Description
810
Failure to Inspect/Monitor
820
Improper Maintenance
830
Improper Use
840
Failure to Respond to Warning
850
Failure to Instruct Patient on Use of
Equipment/Product
860
Malfunction/Failure
890
Biomedical Equipment/Product Related-Not
Otherwise Classified
Table 134 - Miscellaneous
Code
Description
910
Inappropriate Behavior of Clinician (e.g., Sexual
Misconduct Allegation, Assault)
920
Failure to Protect Third Parties (e.g., Failure to
Warn/Protect From Violent Patient Behavior)
930
Breach of Confidentiality/Privacy
940
Failure to Maintain Appropriate Infection Control
950
Failure to Follow Institutional Policy or Procedure
960
Other (Provide Detailed Description)
990
Failure to Review Provider Performance
1
Codes other than those listed above may be returned to the user. These additional codes are no longer
accepted by the NPDB and should be interpreted as ‘UNKNOWN’.
Code Lists Version 2.10
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MMPR Nature of Allegation Codes
Table 135 - MMPR Nature of Allegation Codes
Code Description
001 Diagnosis Related
010 Anesthesia Related
020 Surgery Related
030 Medication Related
040 IV & Blood Products Related
050 Obstetrics Related
060 Treatment Related
070 Monitoring Related
080 Equipment/Product Related
090 Other Miscellaneous
100 Behavioral Health Related
MMPR Report Type Codes
Table 136 - MMPR Report Type Codes
Code Description
I Initial
C Correction
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MMPR Outcome Codes
Table 137 - MMPR Outcome Codes
Code Description
01 Emotional injury only
02 Insignificant injury
03 Minor temporary injury
04 Major temporary injury
05 Minor permanent injury
06 Significant permanent injury
07 Major permanent injury
08 Grave Permanent Injury, such as quadriplegic or brain damage,
requiring lifelong dependent care
09 Death
10 Cannot be determined from available records
Code Lists Version 2.10
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MMPR Specific Allegation Codes
Table 138 - Failure to Take Appropriate Action
Code
Description
100
Failure to Use Aseptic Technique
101
Failure to Diagnose
102
Failure to Delay a Case When Indicated
103
Failure to Identify Fetal Distress
104
Failure to Treat Fetal Distress
105
Failure to Medicate
106
Failure to Monitor
107
Failure to Order Appropriate Medication
108
Failure to Order Appropriate Test
109
Failure to Perform Preoperative Evaluation
110
Failure to Perform Procedure
111
Failure to Perform Resuscitation
112
Failure to Recognize a Complication
113
Failure to Treat
Table 139 - Delay In Performance
Code
Description
200
Delay in Diagnosis
201
Delay in Performance
202
Delay in Treatment
203
Delay in Treatment of Identified Fetal Distress
Table 140 - Error/Improper Performance
Code
Description
300
Administration of Blood or Fluids Problem
301
Agent Use or Selection Error
302
Complementary or Alternative Medication Problem
303
Equipment Utilization Problem
304
Improper Choice of Delivery Method
305
Improper Management
306
Improper Performance
307
Improperly Performed C-Section
308
Improperly Performed Vaginal Delivery
309
Improperly Performed Resuscitation
310
Improperly Performed Test
311
Improper Technique
312
Intubation Problem
313
Laboratory Error
314
Pathology Error
315
Medication Administered via Wrong Route
316
Patient History, Exam, or Workup Problem
317
Problems With Patient Monitoring in Recovery
318
Patient Monitoring Problem
319
Patient Positioning Problem
320
Problem with Appliance, Prostheses, Orthotic,
Restorative, Splint, Device, etc.
321
Radiology or Imaging Error
322
Surgical or Other Foreign Body Retained
323
Wrong Diagnosis or Misdiagnosis
324
Wrong Dosage Administered
325
Wrong Dosage Dispensed
326
Wrong Dosage Ordered of Correct Medication
327
Wrong Medication Administered
328
Wrong Medication Dispensed
329
Wrong Medication Ordered
330
Wrong Body Part
331
Wrong Blood Type
Code
Description
332
Wrong Equipment
333
Wrong Patient
334
Wrong Procedure or Treatment
Table 141 - Unnecessary/Contraindicated Procedure
Code
Description
400
Contraindicated Procedure
401
Surgical or Procedural Clearance Contraindicated
402
Unnecessary Procedure
403
Unnecessary Test
404
Unnecessary Treatment
Table 142 - Communication/Supervision
Code
Description
500
Communication Problem Between Practitioners
501
Failure to Instruct or Communicate with Patient or
Family
502
Failure to Report on Patient Condition
503
Failure to Respond to Patient
504
Failure to Supervise
505
Improper Supervision
Table 143 - Continuity of Care/Care Management
Code
Description
600
Failure/Delay in Admission to Hospital or Institution
601
Failure/Delay in Referral or Consultation
602
Premature Discharge from Institution
603
Altered, Misplaced or Prematurely Destroyed Records
Table 144 - Behavior/Legal
Code
Description
700
Abandonment
701
Assault and Battery
702
Breach of Contract or Warranty
703
Breach of Patient Confidentiality
704
Equipment Malfunction
705
Failure to Conform with Regulation, Statute, or Rule
706
Failure to Ensure Patient Safety
707
Failure to Obtain Consent or Lack of Informed Consent
708
Failure to Protect a Third Party
709
Failure to Test Equipment
710
False Imprisonment
711
Improper Conduct
712
Inadequate Utilization Review
713
Negligent Credentialing
714
Practitioner with Communicable Disease
715
Product Liability
716
Religious Issues
717
Sexual Misconduct
718
Third Party Claimant
719
Vicarious Liability
720
Wrongful Life/Birth
Code Lists Version 2.10
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Table 145 - Other
Code
Description
899
Cannot Be Determined from Available Records
999
Allegation - Not Otherwise Classified,
Specify___________________________
These codes were adapted from code lists developed
by The Risk Management Foundation of the Harvard
Medical Institutions and the Physician Insurers
Association of America.
MMPR Relationship of Entity Codes
Table 146 - MMPR Relationship of Entity Codes
Code Description
P Insurance company – Primary Insurer
E Insurance company – Excess Insurer
S Self-Insured Organization
G Insurance Guaranty Fund
M State Medical Malpractice Payment Fund as the Primary Payer for This Practitioner
O State Medical Malpractice Payment Fund as a Secondary Payer for This Practitioner
MMPR Relationship of Entity Codes (Old Format)
Table 147 - MMPR Relationship of Entity Codes (Old Format)
Code Description
I Insurance company
S Self-Insured Organization
O Other – Guaranty Fund
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MMPR Payment Result Of Codes
Table 148 - MMPR Payment Result Of Codes
Code Description
J Judgment
S Settlement
B Payment Prior to Settlement
O Other
MMPR Payment Result Of Codes (Old Format)
Table 149 - MMPR Payment Result Of Codes (Old Format)
Code Description
J Judgment
S Settlement
B Payment Prior to Settlement
U Unknown
O Other
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December 2022 56
MMPR Payment Type Codes
Table 150 - MMPR Payment Type Codes
Code Description
S A Single Final Payment
M One of Multiple Payments
U Unknown Payment Type (Responses only - do not submit reports with this payment type)
MMPR Patient Type Codes
Table 151 - MMPR Patient Type Codes
Code Description
I Inpatient
O Outpatient
B Both
U Unknown
Code Lists Version 2.10
December 2022 57
Report Transaction Type Codes
Table 152 - Report Transaction Type Codes
Code Description
I Initial: The first record of an adverse action that is submitted to and processed by the NPDB.
An Initial Report is the current version of the report until a Revision to Action, Correction,
Void, or Notice of Appeal is submitted.
C Correction: A report that corrects an error or omission in an existing report. The Correction
will supersede the contents of the current version of a report in the NPDB. It should be
submitted as soon as possible after a reporting error or omission is discovered. Corrections
may be submitted as often as necessary.
V Void: The retraction of a report in its entirety from the NPDB. The report is removed from the
subject’s disclosable record.
R Revision to Action: A new action that relates to and modifies a previously reported adverse
action, (e.g., reinstatement of a license, extension of an exclusion from a Government
program, restrictions of clinical privileges lifted, previously stayed license revocation
imposed).
A correction of a Revision to Action Report may be submitted via the IQRS or
QRXS
O Correction of Revision to Action: A report that corrects a previously submitted Revision to
Action Report. This correction will supersede the contents of the current version of the
Revision to Action Report in the NPDB. It should be submitted as soon as possible after a
reporting error or omission is discovered. Corrections may be submitted as often as
necessary.
A Notice of Appeal: A report notifying the NPDB that a subject has formally appealed a
previously reported adverse action. Under Section 1921 and Section 1128E, reporting
entities must submit a Notice of Appeal whenever a previously reported adverse action is on
appeal. A Notice of Appeal is separate and distinct from a subject's dispute of an NPDB
report. There is no legal requirement for this type of report to be submitted to the NPDB
under Title IV.
Code Lists Version 2.10
December 2022 58
Void Reason Codes
Table 153 - Void Reason Codes
Code
Description
V0 The report
was submitted in error (e.g., wrong practitioner named; duplicate
report; payment not delivered; action never finalized).
V1
The action was not reportable because it did not meet NPDB reporting
requirements.
V2 The action was overturned on appeal. The action was reversed because the
original action should never have been taken.
Subject Source Codes
Table 154 - Subject Source Codes
Code
Description
Q You received the previous version of this report via a query.
R Your entity submitted the previous version of this report.
P You received the previous version of this report via a Continuous Query
enrollment that has since been canceled.
Code Lists Version 2.10
December 2022 59
Transaction Codes
Table 155 - Transaction Codes
Code
Description
PE Continuous Query Enrollment
PU Continuous Query Update
PN Continuous Query Renewal
PC Continuous Query Cancellation
PI Continuous Query Status Request
PD Continuous Query Report Disclosure
1L
Single Query - Individual Subject
1C
Single Query - Organization Subject
1A
Multiple-Name Query - Individual Subject
1J
Multiple-Name Query - Organization Subject
A2 AAR Initial Report
A4 AAR Correction Report
A5 AAR Void Report - Organization Subject
A6 AAR Void Report - Individual Subject
A7 AAR Revision to Action Report
A8 AAR Notice of Appeal - Organization Subject
A9 AAR Notice of Appeal - Individual Subject
J2 JOCR Initial Report
J4 JOCR Correction Report
J5 JOCR Void Report - Organization Subject
J6 JOCR Void Report - Individual Subject
J7 JOCR Revision to Action Report
J8 JOCR Notice of Appeal - Organization Subject
J9
JOCR Notice of Appeal - Individual Subject
M2 MMPR Initial Report
M4 MMPR Correction Report
M6 MMPR Void Report
90 User Account Password Change
91 User Account Password Reset (Only Permitted By Entity Administrator)
DB NPDB Correspondence
Code Lists Version 2.10
December 2022 60
Query Purpose Codes
Table 156 - Query Purpose Codes
Code
Description
P Privileging or Employment
R Professional Review
M Mandatory Two-Year Review (For Use by Hospitals)
S Licensing
F Fraud and Abuse Investigation
G Certification to Participate in a Government Program
I Claims Processing
Continuous Query Enrollment Purpose Codes
Table 157 - Continuous Query Enrollment Purpose Codes
Code
Description
P Privileging or Employment
R Professional Review
M Mandatory Two-Year Review
S Licensing
F Fraud and Abuse Investigation
G Certification to Participate in a Government Program
I Claims Processing
Continuous Query Enrollment Status Codes
Table 158 - Continuous Query Enrollment Status Codes
Code
Description
E Enrolled
N Not Enrolled
S Suspended
C Previously Enrolled
P Pending
Code Lists Version 2.10
December 2022 61
Continuous Query Report Disclosure Reason Codes
Table 159 - Continuous Query Report Disclosure Reason Codes
Code Description
IR The reporting entity identified in this disclosure has submitted Initial Report {1}.
RR The reporting entity identified in this disclosure has submitted Revision to Action Report {1}.
CR
The reporting entity identified in this disclosure has submitted correction(s) to report {1}.
CA
The reporting entity identified in this disclosure has submitted correction(s) to report {1}.
DA The subject of report {1} has filed a dispute with the NPDB concerning information contained in
the report. The reporting entity identified in this disclosure and the subject of the report are
responsible for settling the dispute.
DW The subject of report {1} has withdrawn the dispute originally associated with this report.
SA The subject of report {1} has added a statement to the report to explain or comment on the
action reported.
SW The subject of report {1} has withdrawn the statement previously associated with this report.
NA The reporting entity identified in this disclosure has indicated that the action described in report
{1} is being appealed.
RE The subject of report {1} has requested that this dispute be reviewed by the Secretary of the
U.S. Department of Health and Human Services.
RW
The subject of report {1} has withdrawn the request for review of this dispute by the Secretary of
the U.S. Department of Health and Human Services.
RD The Secretary of the U.S. Department of Health and Human Services has reviewed the facts of
the dispute and has made a determination regarding report {1}.
VR Report {1} and all information in it have been expunged from the NPDB and should not be used.
Please destroy all copies of this report.
OC On behalf of the reporting entity identified in this disclosure, the NPDB corrected report {1}. The
following data fields have been modified: {2}.
OA
On behalf of the reporting entity identified in this disclosure, the NPDB corrected report {1}. The
following data fields have been modified: {2}.
RC On behalf of the reporting entity identified in this disclosure, the NPDB corrected report {1} as
directed by the Secretary of the U.S. Department of Health and Human Services. For further
information, see the Secretary’s comments included in this disclosure.
RA On behalf of the reporting entity identified in this disclosure, the NPDB corrected report {1} as
directed by the Secretary of the U.S. Department of Health and Human Services. For further
information, see the Secretary’s comments included in this disclosure.
OV
On behalf of the reporting entity identified in this disclosure, the NPDB voided report {1}
because it was determined to be a duplicate report. Please destroy all copies of report {1}. The
original report remains in the NPDB.
Code Lists Version 2.10
December 2022 62
Code
Description
RV
On behalf of the reporting entity identified in this disclosure, the NPDB voided report {1} as
directed by the Secretary of the U.S. Department of Health and Human Services. The
referenced report and all information in it have been expunged from the NPDB and should not
be used. Please destroy all copies of this report.
BI Correction Report {1} should have been submitted as a Revision to Action since it modifies a
previously reported action. To correct this, the NPDB, on behalf of the reporting entity identified
in this disclosure, have re−submitted the original or previous Initial Report as {2}. Additionally,
the Correction Report {1} has been voided and re−submitted as Revision to Action {3}. Please
destroy all copies of report {1}.
BV Correction Report {1} should have been submitted as a Revision to Action since it modifies a
previously reported action. To correct this, the NPDB, on behalf of the reporting entity identified
in this disclosure, have re−submitted the original or previous Initial Report as {2}. Additionally,
the Correction Report {1} has been voided and re−submitted as Revision to Action {3}. Please
destroy all copies of report {1}.
BR
Correction Report {1} should have been submitted as a Revision to Action since it modifies a
previously reported action. To correct this, the NPDB, on behalf of the reporting entity identified
in this disclosure, have re−submitted the original or previous Initial Report as {2}. Additionally,
the Correction Report {1} has been voided and re−submitted as Revision to Action {3}. Please
destroy all copies of report {1}.
AV On behalf of the reporting entity identified in this disclosure, the NPDB converted report {1} to
Revision to Action Report {2}. This action should have been reported as a Revision to Action
since it modifies the previously reported action {3}. Please destroy all copies of report {1}.
AR On behalf of the reporting entity identified in this disclosure, the NPDB converted report {1} to
Revision to Action Report {2}. This action should have been reported as a Revision to Action
since it modifies the previously reported action {3}. Please destroy all copies of report {1}.
NM Report {1} no longer matches the enrolled subject profile for {2}. Please disregard and destroy
all previous versions of this report and any copies.
ND Report {1} is no longer disclosable to your entity. Please disregard and destroy all previous
versions of this report and any copies.
EC
Initial Enrollment Disclosure
UC Enrollment Update Disclosure
RQ At the request of the subject, report {1} was reviewed by the Secretary of the U.S. Department
of Health and Human Services and a decision was reached. The subject has requested that the
Secretary reconsider the original decision.
Note(s):
The descriptions listed herein contain placeholder references ({1}, {2}, and {3}) and each will be replaced with an
actual report DCN when a notification is generated by the NPDB.
Code Lists Version 2.10
December 2022 63
Occupation/Field of Licensure Codes
Table 160 – Physician
Code
Description
010
Physician (MD)
015
Physician Resident (MD)
020
Osteopathic Physician (DO)
025
Osteopathic Physician Resident (DO)
Table 161 – Nurse – Advanced, Registered, Practical, or
Vocational
Code
Description
100
Registered Nurse
110
Nurse Anesthetist
120
Nurse Midwife
130
Nurse Practitioner
140
Licensed Practical or Vocational Nurse
141
Clinical Nurse Specialist
142
Other Nurse Occupation - Not Classified, Specify,
__________
Table 162 – Nurse Aide, Home Health Aide and Other
Aide
Code
Description
150
Nurse Aide/Nursing Assistant
160
Home Health Aide (Homemaker)
165
Health Care Aide/Direct Care Worker
175
Certified or Qualified Medication Aide
176
Other Aide Occupation - Not Classified, Specify,
__________
Table 163 – Dental Service Practitioner
Code
Description
030
Dentist
035
Dental Resident
606
Dental Assistant
607
Dental Therapist/Dental Health Aide
609
Dental Hygienist
612
Denturist
613
Other Dental Occupation - Not Classified, Specify,
__________
Table 164 – Chiropractor
Code
Description
603
Chiropractor
604
Chiropractic Assistant
605
Other Chiropractic Occupation - Not Classified,
Specify, __________
Table 165 – Behavioral Health Occupations
Code
Description
621
Counselor, Mental Health
651
Professional Counselor
660
Addictions Counselor
652
Sex Offender Counselor
653
Pastoral Counselor
661
Marriage and Family Therapist
662
Art Therapist
664
Recreation Therapist
665
Dance Therapist
667
Music Therapist
668
Other Behavioral Health Occupation - Not
Classified, Specify, __________
Table 166 – Dietitian/Nutritionist
Code
Description
200
Dietitian
210
Nutritionist
211
Other Dietitian/Nutritionist Occupation - Not
Classified, Specify, __________
Table 167 – Emergency Medical Technician (EMT)
Code
Description
240
Emergency Medical Responder
250
Emergency Medical Technician
270
Emergency Medical Technician, Advanced
280
Paramedic
281
Other Emergency Medical Technician - Not
Classified, Specify, __________
Table 168 – Eye and Vision Service Practitioner
Code
Description
630
Ocularist
633
Optician
636
Optometrist
637
Other Eye and Vision Service Occupation - Not
Classified, Specify, __________
Table 169 – Pharmacy Service Practitioner
Code
Description
050
Pharmacist
055
Pharmacy Intern
070
Pharmacy Assistant
075
Pharmacy Technician
076
Other Pharmacy Service Occupation - Not
Classified, Specify, __________
Table 170 – Physician Assistant
Code
Description
642
Physician Assistant
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Table 171 – Podiatric Service Practitioner
Code
Description
350
Podiatrist
648
Podiatric Assistant
649
Other Podiatric Service Occupation - Not Classified,
Specify, __________
Table 172 – Psychologist/Psychological Assistant
Code
Description
371
Psychologist
372
School Psychologist
373
Psychological Assistant, Associate, Examiner
374
Other Psychologist/Psychological Assistant
Occupation - Not Classified, Specify, __________
Table 173 – Rehabilitative, Respiratory and Restorative
Service Practitioner
Code
Description
405
Massage Therapist
410
Occupational Therapist
420
Occupational Therapy Assistant
430
Physical Therapist
440
Physical Therapy Assistant
450
Rehabilitation Therapist
663
Respiratory Therapist
666
Respiratory Therapy Technician
658
Other Rehabilitative, Respiratory and Restorative
Service Occupation - Not Classified, Specify,
__________
Table 174 – Social Worker
Code
Description
300
Social Worker
Table 175 – Speech, Language and Hearing Service
Practitioner
Code
Description
400
Audiologist
460
Speech/Language Pathologist
470
Hearing Aid (or Instrument) Specialist, Dealer,
Dispenser or Fitter
471
Other Speech, Language and Hearing Service
Occupation - Not Classified, Specify, __________
Table 176 – Technologist/Technician
Code
Description
501
Medical or Clinical Lab Technician/Technologist
503
Surgical Technologist/Assistant
505
Cytotechnologist
510
Nuclear Medicine Technologist
520
Radiation Therapy Technologist
530
Radiologic Technician/Technologist
551
Other Technologist/Technician - Not Classified,
Specify, __________
Table 177 – Other Health Care Practitioner
Code
Description
600
Acupuncturist
601
Athletic Trainer
615
Homeopath
618
Medical Assistant
624
Midwife, Lay (Non-Nurse)
627
Naturopath
639
Orthotics/Prosthetics Fitter
647
Perfusionist
170
Psychiatric Technician
699
Other Health Care Practitioner - Not Classified,
Specify, __________
Table 178 – Health Care Facility Administrator
1
Code
Description
758
Health Care Facility Administrator
Table 179 – Other Occupation
1
Code
Description
850
Accountant
853
Bookkeeper
822
Business Manager
830
Business Owner
820
Corporate Officer
810
Insurance Agent/Broker
800
Researcher, Clinical
840
Salesperson
899
Other Occupation - Not Classified, Specify,
__________
1
Health Care Facility Administrator and Other
Occupation codes are not available for Clinical
Privilege and Professional Society actions and Peer
Review Organization findings.
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Occupation/Field of Licensure Codes – Retired
Table 180 – Occupation/Field of Licensure Codes – Retired
Code
Description
060
Pharmacist, Nuclear
134
Doctor of Nursing Practice
135
Advanced Practice Nurse
148
Certified Nurse Aide/Certified Nursing Assistant
260
EMT, Cardiac/Critical Care
370
Psychologist, Clinical
402
Art/Recreation Therapist
500
Medical Technologist
502
Medical or Clinical Laboratory Technician
504
Surgical Assistant
540
X-Ray Technician or Operator
550
Limited X-Ray Machine Operator (LXMO)
645
Physician Assistant, Osteopathic
654
Professional Counselor, Alcohol
657
Professional Counselor, Family/Marriage
752
Adult Care Facility Administrator
755
Hospital Administrator
759
Assisted Living Facility Administrator
812
Insurance Broker
Retired Codes are not available for submission on new reports or queries but may appear on existing reports.
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Specialty Codes
Table 181 - Physician Specialties
Code
Description
01
Allergy and Immunology
03
Aerospace Medicine
05
Anesthesiology
10
Cardiovascular Diseases
13
Child Psychiatry
20
Dermatology
23
Diagnostic Radiology
25
Emergency Medicine
29
Forensic Pathology
30
Gastroenterology
33
General Practice/Family Practice
35
General Preventive Medicine
37
Hospitalist
39
Internal Medicine
40
Neurology
43
Neurology, Clinical Neurophysiology
45
Nuclear Medicine
50
Obstetrics & Gynecology
53
Occupational Medicine
55
Ophthalmology
59
Otolaryngology
60
Pediatrics
63
Psychiatry
65
Public Health
67
Clinical Pharmacology
69
Physical Medicine & Rehabilitation
70
Pulmonary Diseases
73
Anatomic/Clinical Pathology
75
Radiology
76
Radiation Oncology
80
Colon and Rectal Surgery
81
General Surgery
82
Neurological Surgery
83
Orthopedic Surgery
84
Plastic Surgery
85
Thoracic Surgery
86
Urological Surgery
98
Other Specialty - Not Classified
99
Unspecified
Table 182 - Dental Specialties
Code
Description
D1
General Dentistry (No Specialty)
D2
Dental: Public Health
D3
Endodontics
D4
Oral and Maxillofacial Surgery
D5
Oral and Maxillofacial Pathology
D6
Orthodontics and Dentofacial Orthopedics
D7
Pediatric Dentistry
D8
Periodontics
D9
Prosthodontics
DA
Oral and Maxillofacial Radiology
DB
Unknown
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Entity Status Codes
Table 183 - Entity Status Codes
Code
Type
Description
A
Original Reporting Entity
is Active
The entity that filed the report may have changed its name or address
on file with the NPDB. The most recent entity contact information
reported to the NPDB and the date on which it was reported is
provided.
S Original Reporting Entity
is Inactive but has a
Successor
The entity that filed the report is no longer an active registrant with the
NPDB. The most recent information for the registered successor
entity is provided.
D Original Reporting Entity
is Inactive with no
Successor
The entity that filed the report is no longer an active registrant with the
NPDB. The most recent entity contact information reported to the
NPDB and the date on which it was reported is provided. The NPDB
have no additional information regarding this entity.
N
Original Reporting Entity
is Inactive and its
Successor is Inactive
The entity that filed the report is no longer an active registrant with the
NPDB. The most recent information for the registered successor
entity is provided, but that entity is also no longer an active registrant
with the NPDB. The NPDB has no additional information regarding
this entity.
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State Abbreviations and U.S. Territories
Table 184 – States
Code
Description
AL
Alabama
AK
Alaska
AZ
Arizona
AR
Arkansas
CA
California
CO
Colorado
CT
Connecticut
DE
Delaware
DC
District of Columbia
FL
Florida
GA
Georgia
HI
Hawaii
ID
Idaho
IL
Illinois
IN
Indiana
IA
Iowa
KS
Kansas
KY
Kentucky
LA
Louisiana
ME
Maine
MD
Maryland
MA
Massachusetts
MI
Michigan
MN
Minnesota
Code
Description
MS
Mississippi
MO
Missouri
MT
Montana
NE
Nebraska
NV
Nevada
NH
New Hampshire
NJ
New Jersey
NM
New Mexico
NY
New York
NC
North Carolina
ND
North Dakota
OH
Ohio
OK
Oklahoma
OR
Oregon
PA
Pennsylvania
RI
Rhode Island
SC
South Carolina
SD
South Dakota
TN
Tennessee
TX
Texas
UT
Utah
VT
Vermont
VA
Virginia
WA
Washington
Code
Description
WV
West Virginia
WI
Wisconsin
WY
Wyoming
Table 185 - Territories
Code
Description
AS
American Samoa
FM
Federated States of
Micronesia
GU
Guam
MP
Northern Marianas
PW
Palau
PR
Puerto Rico
VI
Virgin Islands
Table 186 - Armed Forces
Code
Description
AA
Central and South America
AE
Europe
AP
Pacific
Please adhere to the following guidelines when entering foreign or military addresses:
Addresses for United States Territories:
● Enter Territory abbreviation in "State" field.
Addresses outside the United States or its territories:
● Leave the "State" field blank.
● Enter the city and/or province in the "City" field.
● Enter the Country Code in the "ZIP" fields - maximum 5 characters in first field, maximum 4 characters in the second field.
● Enter the country in the "Country" field.
Military Addresses:
● Enter APO in the "City" field.
● Enter AE, AA in the "State" field.
● Enter the ZIP code in the "ZIP" field.
Following State Codes are not valid for State of Licensure:
● AA Central and South America (Armed Forces)
● AE Europe (Armed Forces)
● AP Pacific (Armed Forces)
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APO/FPO Postal Codes
Table 187 - AE - Europe
First 3 digits of ZIP Code
Geographic Area
090-092
Germany
094
United Kingdom
095
Atlantic Ocean/ Mediterranean Sea Ships
096
Italy, Spain
097
Other Europe
098
Middle East, Africa
Table 188 - AA - Americas
First 3 digits of ZIP Code
Geographic Area
340
Central, South Americas
Table 189 - AP - Pacific
First 3 digits of ZIP Code
Geographic Area
962
Korea
963
Japan
964
Philippines
965
Other Pacific and Alaska
966
Pacific and Indian Ocean Ships
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Type of Organization Codes
Table 190 - Group or Practice
Code
Description
361
Chiropractic Group/Practice
362
Dental Group/Practice
365
Medical Group/Practice
366
Mental Health/Substance Abuse Group/Practice
363
Optician/Optometric Group/Practice
367
Physical/Occupational Therapy Group/Practice
364
Podiatric Group/Practice
Table 191 - Home Health Agency/ Organization
Code
Description
393
Home Health Agency/Organization
Table 192 - Hospice/Hospice Care Provider
Code
Description
382
Hospice/Hospice Care Provider
Table 193 - Hospital
Code
Description
304
Federal Hospital
301
General/Acute Care Hospital
302
Psychiatric Hospital
303
Rehabilitation Hospital
Table 194 - Hospital Unit
Code
Description
307
Psychiatric Unit
308
Rehabilitation Unit
Table 195 - Laboratory/CLIA Laboratory
Code
Description
310
Laboratory/CLIA Laboratory
Table 196 - Nursing Facility/Skilled Nursing Facility
Code
Description
389
Nursing Facility/Skilled Nursing Facility
Table 197 - Research Center/Facility
Code
Description
370
Research Center/Facility
Table 198 - Ambulance Service/Transportation
Company
Code
Description
390
Ambulance Service/Transportation Company
Table 199 - Health Insurance Company/Provider
Code
Description
320
Health Insurance Company/Provider
Table 200 - Other Health Care Facility
Code
Description
381
Adult Day Care Facility
392
Ambulatory Clinic/Center
391
Ambulatory Surgical Center
398
End Stage Renal Disease Facility
394
Health Center/Federally Qualified Health
Center/Community Health Center
383
Intermediate Care Facility for Intellectually
Disabled/Substance
397
Mammography Service Provider
395
Mental Health Center/Community Mental Health
Center
388
Outpatient Rehabilitation Facility/
Comprehensive Outpatient Rehabilitation Facility
399
Radiology/Imaging Center
386
Residential Treatment Facility/ Program
396
Rural Health Clinic
Table 201 - Managed Care Organization
Code
Description
331
Health Maintenance Organization
335
Preferred Provider Organization
336
Provider Sponsored Organization
338
Religious, Fraternal Benefit Society Plan
Table 202 - Health Care Supplier/Manufacturer
Code
Description
347
Biological Products Manufacturer
1
342
Blood Bank
343
Durable Medical Equipment Supplier
1
344
Eyewear Equipment Supplier
1
351
Fiscal/Billing/Management Agent
1
353
Nursing/Health Care Staffing Service
1
348
Organ Procurement Organization
1
345
Pharmacy
346
Pharmaceutical Manufacturer
1
349
Portable X-Ray Supplier
1
352
Purchasing Service
1
Table 203 - Other
Code
Description
999
Other Type - Not Classified, Specify,
______________
1 These organization type codes are not available for
Accreditation action and Peer Review Organization
findings.
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Report Change Notification Disclosure Type Codes
Table 204 - Report Change Notification Disclosure Type Codes
Code Description
IR The reporting entity identified in this disclosure has submitted Initial Report {1}.
RR The reporting entity identified in this disclosure has submitted Revision to Action Report {1}.
CR The reporting entity identified in this disclosure has submitted correction(s) to report {1}.
CA
The reporting entity identified in this disclosure has submitted correction(s) to report {1}.
DA The subject of report {1} has filed a dispute with the NPDB concerning information contained in
the report. The reporting entity identified in this disclosure and the subject of the report are
responsible for settling the dispute.
DW The subject of report {1} has withdrawn the dispute originally associated with this report.
SA
The subject of report {1} has added a statement to the report to explain or comment on the
action reported.
SW The subject of report {1} has withdrawn the statement previously associated with this report.
NA The reporting entity identified in this disclosure has indicated that the action described in report
{1} is being appealed.
RE
The subject of report {1} has requested that this dispute be reviewed by the Secretary of the
U.S. Department of Health and Human Services.
RW
The subject of report {1} has withdrawn the request for review of this dispute by the Secretary
of the U.S. Department of Health and Human Services.
RD The Secretary of the U.S. Department of Health and Human Services has reviewed the facts of
the dispute and has made a determination regarding report {1}.
VR Report {1} and all information in it have been expunged from the NPDB and should not be
used. Please destroy all copies of this report.
OC On behalf of the reporting entity identified in this disclosure, the NPDB corrected report {1}.
The following data fields have been modified: {2}.
OA On behalf of the reporting entity identified in this disclosure, the NPDB corrected report {1}.
The following data fields have been modified: {2}.
RC On behalf of the reporting entity identified in this disclosure, the NPDB corrected report {1} as
directed by the Secretary of the U.S. Department of Health and Human Services. For further
information, see the Secretary’s comments included in this disclosure.
RA On behalf of the reporting entity identified in this disclosure, the NPDB corrected report {1} as
directed by the Secretary of the U.S. Department of Health and Human Services. For further
information, see the Secretary’s comments included in this disclosure.
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Code Description
OV On behalf of the reporting entity identified in this disclosure, the NPDB voided report {1}
because it was determined to be a duplicate report. Please destroy all copies of report {1}.
The original report remains in the NPDB.
RV On behalf of the reporting entity identified in this disclosure, the NPDB voided report {1} as
directed by the Secretary of the U.S. Department of Health and Human Services. The
referenced report and all information in it have been expunged from the NPDB and should not
be used. Please destroy all copies of this report.
BI Correction Report {1} should have been submitted as a Revision to Action since it modifies a
previously reported action. To correct this, the NPDB, on behalf of the reporting entity
identified in this disclosure, have re−submitted the original or previous Initial Report as {2}.
Additionally, the Correction Report {1} has been voided and re−submitted as Revision to Action
{3}. Please destroy all copies of report {1}.
BV Correction Report {1} should have been submitted as a Revision to Action since it modifies a
previously reported action. To correct this, the NPDB, on behalf of the reporting entity
identified in this disclosure, have re−submitted the original or previous Initial Report as {2}.
Additionally, the Correction Report {1} has been voided and re−submitted as Revision to Action
{3}. Please destroy all copies of report {1}.
BR
Correction Report {1} should have been submitted as a Revision to Action since it modifies a
previously reported action. To correct this, the NPDB, on behalf of the reporting entity
identified in this disclosure, have re−submitted the original or previous Initial Report as {2}.
Additionally, the Correction Report {1} has been voided and re−submitted as Revision to Action
{3}. Please destroy all copies of report {1}.
AV On behalf of the reporting entity identified in this disclosure, the NPDB converted report {1} to
Revision to Action Report {2}. This action should have been reported as a Revision to Action
since it modifies the previously reported action {3}. Please destroy all copies of report {1}.
AR On behalf of the reporting entity identified in this disclosure, the NPDB converted report {1} to
Revision to Action Report {2}. This action should have been reported as a Revision to Action
since it modifies the previously reported action {3}. Please destroy all copies of report {1}.
ND
Report {1} is no longer disclosable to your entity. Please disregard and destroy all previous
versions of this report and any copies.
RQ
At the request of the subject, report {1} was reviewed by the Secretary of the U.S. Department
of Health and Human Services and a decision was reached. The subject has requested that
the Secretary reconsider the original decision.
Note(s):
The descriptions listed herein contain placeholder references ({1}, {2}, and {3}) and each will be replaced with an
actual report DCN when a notification is generated by the NPDB.
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Gender Codes
Table 205 - Gender Codes
Code Description
M Male
F Female
U Unknown
D
ispute Status Codes
Table 206 - Dispute Status Codes
Code
Description
N Report is not in dispute.
Y
The subject of the referenced report has filed a dispute with the NPDB concerning information
contained in the report.
S The subject of the referenced report has requested that this dispute be reviewed by the Secretary of
the U.S. Department of Health and Human Services.
R The Secretary of the U.S. Department of Health and Human Services has reviewed the facts of the
dispute and has reached a decision.
Q At the request of the subject, the referenced report was reviewed by the Secretary of the U.S.
Department of Health and Human Services and a decision was reached. The subject has requested
that the Secretary reconsider the original decision.
S
tatutory Authority Codes
Table 207 – Statutory Authority QRXS Codes
Code Description
IV Report is maintained under the provisions of Title IV of Public Law 99-660.
1921 Report is maintained under the provisions of Section 1921.
1128E Report is maintained under the provisions of Section 1128E.
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Error Codes
Table 208 - Error Codes
Code Description
03 File is not compliant with the current format version.
05 SQL error.
06 Invalid transaction code entered.
07 Invalid Data Bank ID.
08 Invalid password.
09 This entity does not have the privilege to perform this transaction.
11 Entity registration has expired.
12 Agent registration has expired.
13 This agent does not have the authority to act for entity.
15 Entity name or Data Bank ID is missing or illegible.
16 All or part of the entity address is missing or invalid.
18 Invalid entity type code.
20 All or part of a subject's name is missing or invalid. Subject First Name and Last Name are required.
22 Invalid subject type.
23
Incomplete subject Occupation/Field of Licensure information. For each license number you provide,
you must also provide a valid, two-letter abbreviation for the U.S. State from where the license was
issued, and a valid, three-digit Occupation/Field of Licensure code.
24 Invalid Occupation/Field of Licensure code.
25 All or part of school information is missing or illegible: professional school information must include both
the name of the professional health care school attended and the year the subject graduated. If the
subject did not graduate, provide the last year he or she attended the school-this will be presented on
the response as the subject year of graduation.
26 Invalid Drug Enforcement Administration number.
27 Invalid Social Security Number.
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Code Description
28 Missing, invalid, or illegible date of birth. Date of birth must be at least 15 years before today's date and
after 1900.
29 Invalid gender code.
30 Adverse Action Report data is missing or illegible: required information is missing in section C of the
Adverse Action Report you submitted. Each of the fields in this section must be completed legibly.
Please submit a new, fully completed adverse action report to the NPDB. Do not reference Data Bank
Control Number of this rejection notice on your new report. If this rejected report was an initial report,
you must submit a new initial report; if a correction or void was rejected, you must resubmit your
correction or void as if this rejected report was never submitted to the NPDB.
31 Invalid Adverse Action Classification code.
32 Invalid Adverse Action type code: the type of Adverse Action taken (licensure, clinical privileges, or
professional society membership) was not indicated in field 3 of your Adverse Action Report form, or
more than one type was marked. Please submit a new, fully completed Adverse Action Report to the
NPDB, indicating the type of adverse action your organization is reporting. Do not reference the
document control number of this rejection notice on your new report. If this rejected report was an initial
report, you must submit a new initial report; if a correction or void was rejected, you must resubmit your
correction or void as if this rejected report was never submitted to the NPDB.
33 Invalid Omission code.
34 Medical Malpractice Payment Report data is missing or illegible: required information is missing or
illegible in section C of the Medical Malpractice Payment Report you submitted. Each of the unshaded
fields in this section must be completed legibly. Please submit a new, fully completed Medical
Malpractice Payment Report to the NPDB. Do not reference the Data Bank Control Number of this
rejection notice on your new report. If this rejected report was an initial report, you must submit a new
initial report; if a correction or void was rejected, you must resubmit your correction or void as if this
rejected report was never submitted to the NPDB.
35 Invalid Hospital data. A valid Name, City, and State are required for each hospital provided.
36 Missing or invalid relation of entity to subject.
37 Invalid payment type.
38 Missing or invalid payment result.
39 All or part of certification is missing: you must provide your printed name, your title (except for individual
subject self-queries), your daytime telephone number, your signature, and the date you signed the form.
Please submit a new, fully completed form to the NPDB.
40 All or part of notarization is missing: to be legal and valid, a notarized form must include the notary
public's signature; the date that the practitioner appeared before the notary; the date the notary's
commission expires; and the notary's stamp, seal, or notary number. Please submit a new, fully
completed and notarized form to the NPDB.
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Code Description
41 Missing or invalid credit card information. The NPDB accepts VISA, MasterCard, Discover or American
Express. The NPDB does not accept cash, checks or money orders.
42 Your registered entity does not have a valid EFT account on file.
43 Expired credit card: please contact your credit card company for further information.
44 Rejected credit card: the bank that issued your credit card has denied these charges. No further
information was made available to the NPDB regarding the reason for this rejection. Please contact
your credit card company for further information.
45 Duplicate report.
46 Data Bank Control Number of report to be voided or corrected is missing or invalid.
47 Query data is missing.
48 Invalid Query Purpose code.
49 Time to dispute a report has expired.
50 Valid Data Bank Control Number of report to be corrected or voided was not provided.
51 Cannot dispute a changed/voided report.
52 Attempted to correct or void a report that has been previously voided or replaced by a corrected
version.
53 Report is already in dispute.
54 Report is already in Report Review.
55 Report is not in dispute: cannot withdraw dispute.
56 Report is not in Report Review: cannot withdraw dispute.
57 Control character (non-alphanumeric) found in file.
58 Possible data entry error found.
59 Credit card bill authorization error.
60
File is not in the appropriate format. Check to ensure that the file is not zipped or in binary format (e.g.,
MS Word or Corel WordPerfect) prior to resubmission.
61 Query file with this name has already been processed.
62 Cannot access drive.
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Code Description
63 Damaged diskette.
64 Bad sector(s) on disk.
65 Warning detection error.
66 No files found on disk.
67 I/O error.
68 Missing, invalid, or illegible date of omission. Date of omission must not be later than today's date and
not earlier than 1900.
69 Graduation year is inconsistent with year of birth: the subject's date of birth and year of graduation must
be at least 15 years apart.
70 Length of action is missing or contains more than two digits.
71 Invalid Agent Identification Number.
72 Entity does not have active status.
73 Agent does not have active status.
74 Possible @ sign in data.
75 Invalid entity phone number.
76 Invalid entity phone extension.
77 Invalid certification phone number.
78 Invalid certification phone extension.
79 Invalid subject deceased flag.
80 Invalid subject identification number.
81 Invalid subject address.
82 Invalid payment on Medical Malpractice Payment Report.
83 Invalid Medical Malpractice Payment Report data.
84 Invalid report category code.
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Code Description
85 Credit card authorization unavailable: the NPDB experienced communications problems with our credit
card authorization service when we attempted to bill your account for the enclosed query. As a result,
the charges were not fully authorized and we are unable to process the query. Your credit card account
may show a temporary hold for these charges that will expire within 10 days of the process date shown
above. If, for any reason, you are billed for the enclosed query file, please contact the NPDB Customer
Service Center immediately at 1-800-767-6732. Please create a new query file for the subject names
you need to have processed and transmit it to the NPDB. We regret any inconvenience that this may
cause.
93 Invalid user account.
94 Invalid date of judgment or sentence. The date must be a valid date and must not occur in the future.
99 Billing problem - transaction on hold.
A1 Invalid type of adverse action.
A2 The Name of Agency or Program That Took the Adverse Action is missing or invalid.
A3 Invalid or duplicate Adverse Action Classification code.
A4 Invalid entry for total amount of monetary penalty, assessment, restitution and/or fine.
A5 Invalid entry for date of action, date of finding, or date action became effective.
A6 Invalid length of action.
A7 Invalid entry in automatic reinstatement field.
A8
Missing narrative description of subject’s act(s) or omission(s) or other reasons for action(s) taken and
description of action(s) taken by the reporting entity.
A9 Invalid entries in the publicly available or professional competence or conduct field.
AA This submission could not be processed for the following reason(s). Invalid combination of Adverse
Action Classification codes. State Licensure or Certification actions taken against health care
practitioners may not contain multiple codes when one of the following codes is reported: 1138, 1139,
1149, 1150, or 1189. DEA/Federal Licensure actions taken by the DEA against health care practitioners
may not contain multiple codes when one of the following codes is reported: 1149, 1173, or 1189.
Exclusion/Debarment actions taken by the HHS Office of Inspector General may not contain multiple
codes when one of the following codes is reported: 1508, 1509, 3508, or 3509. Additional actions
should be submitted in separate reports.
AB Duplicate Type of Negative Finding code.
AC Length of action information should not be included in the report for the selected Adverse Action
Classification codes.
AD Name of Agency or Program that took the Adverse Action is not allowed for this report type.
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Code Description
AE The QRXS does not accept transactions related to Adverse Action Reports in legacy format.
AF This agent does not have authority to perform this action for this entity.
AG Invalid date of action or date of finding. For a Revision to Action report, the date of action or date of
finding must be the same as or later than the date of action or date of finding on the initial report.
AH Invalid combination of Adverse Action Classification codes. State Licensure or Certification actions
taken against a multi-state license may not contain multiple codes when one of the following codes is
reported: 1338 or 1339. Additional actions should be submitted in separate reports.
AI Status codes in Licensure Actions and Multi-State Licensure Privilege Actions cannot be selected
together.
AM
Invalid combination of Adverse Action Classification codes. State Licensure or Certification actions
taken against organizations may not contain multiple codes when code 3238 is reported. Additional
actions should be submitted in separate reports.
AN Automatic reinstatement field is only allowed when a specific length of action is specified.
AO Automatic reinstatement field is not allowed with the specified Adverse Action Classification code(s).
B1 Incomplete individual subject Occupation/Field of Licensure.
B2 Incomplete or invalid subject Occupation/Field of Licensure information. For each License provided, a
valid, two-letter abbreviation for the U.S. State from where the license was issued and a valid, three-
digit Occupation/Field of Licensure code must be provided. License Numbers must contain at least one
digit. If the subject does not have a license, specify No License and do not provide a License Number.
An Occupation/Field of Licensure Description is required if the Occupation/Field of Licensure code is
"Other", and not allowed otherwise.
B3 The specialty code selected is either invalid or incompatible with the occupation/field of licensure code
selected. Physician specialty codes should only be used for physicians (occupation/field of licensure
codes 010, 015, 020 and 025). Dental specialty codes should only be used for dentists
(occupation/field of licensure codes 030 and 035).
B4 Invalid organization subject license number.
B5 Incomplete or invalid subject Licensure information. For each License provided, a valid, two-letter
abbreviation for the U.S. State from where the license was issued must be provided. License numbers
must contain at least one digit. If the subject does not have a license, specify No License and do not
provide a License Number.
B6 Invalid organization subject license number State field.
B8 Act or Omission code missing or invalid.
B9 Missing Judgment or Conviction Report information.
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BA Specialty code is a required field for this occupation/field of licensure selection.
BB The specialty code must not be specified for Clinical Privilege or Professional Society actions.
C0 Incomplete or invalid Organization Name or Type information. For each organization, you must provide
a valid Organization Name and Organization Type. An Other Description is required if the Organization
Type is 999, and not allowed otherwise.
C1 Missing or invalid sentence/judgment information.
C4 Invalid Food and Drug Administration number(s).
C5 Invalid National Provider Identifier(s).
C6 Invalid Federal Employer Identification Number(s).
C7
Invalid affiliation data. For each provided affiliate, a valid name is required. If an affiliate address is
provided, the city and state (or city and country) are required. An Other Description is required if the
Nature of Relationship code is 999, and not allowed otherwise.
C8
Invalid appeal information. Specify if the report is on appeal, and only provide an appeal date if the
report is on appeal.
C9 Incomplete information for statutory offenses and counts.
CC orgDefn not allowed for this report type.
CD CCB not allowed for this report type.
CE At least one SSN or FEIN must be provided for Organization Subject.
CF Negative Finding Date not allowed for this report type.
CG Invalid date of judgment or sentence. For a Revision to Action report, the date of judgment or sentence
must be the same as or later than the date of judgment or sentence on the initial report.
CV You may not void a report that has related Revision to Action reports. You must first void the Revision
to Action reports before voiding this report. You can view the related Revision to Action reports by
attempting to void this report using the IQRS (https://www.npdb.hrsa.gov).
D0 Invalid deceased date.
D2 Invalid health care entity definition entry.
D3 Invalid type of organization.
D4 Missing organization name.
D5 Missing or invalid Basis for Action code.
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D6 Report is not valid under any NPDB statutory authority.
D7 This type of report does not accept notices of appeal.
D8 You do not have the statutory authority to submit a notice of appeal for this report.
D9 Professional school and year of graduation should not be present for non-practitioners.
DA Missing or invalid basis for action description.
E0 Missing basis code.
E1 No basis code should be present for revision to actions.
E4 Publicly available field should not be filled in.
E5 Missing competence or conduct basis entry.
E6 Competence or conduct entry not applicable to your report.
F2 The NPDB no longer accepts Adverse Action Reports submitted via disk. All Adverse Action Reports
submitted to the NPDB must be submitted through the Integrated Querying and Reporting Service
found on the World Wide Web at www.npdb.hrsa.gov.
F5 A revision to action transaction attempted to modify certain fields that must contain the same
information as the report being revised: 'Type of Action', 'Occupation/Field of Licensure' if you are filing
a report on an individual subject, as well as 'Competence/Conduct Basis' if you are filing a State
Licensure or Certification report on an individual subject, or 'Health Care Entity Definition' if you are
filing a State Licensure or Certification report on an organizational subject.
F6 The previous DCN did not match a report in the NPDB.
F7 A transaction type was not found for the specified report.
F8 The previous DCN is not applicable for this type of report.
F9 A correction of revision to action transaction attempted to correct a non-revision to action report.
G1 Set A and set B mandatory fields not complete for individual query.
G2 Set A and set B mandatory fields not complete for organization query.
G3 Missing/invalid notary date
G4 Missing/invalid notary seal, stamp, or certificate.
G5 Missing/invalid notary signature.
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G6 Missing/invalid subject appearance date.
G7 Missing/invalid subject signature.
G8 Invalid number of subjects in query.
G9 Invalid batch query. Individual and organization subjects may not be queried on in the same query
batch.
H4 This subject is a duplicate of a subject submitted as DCN <DCN of previously queried subject>
I1 Invalid Individual Taxpayer Identification Number(s).
I2 At least one ITIN or SSN must be provided for Individual Subject.
I3 At least one ITIN, SSN or FEIN must be provided for Organization Subject.
I4 Invalid Unique Physician Identification Number(s).
I5 Invalid Principal Officers and Owners information.
I6 Invalid Medicare Provider/Supplier Number(s).
I7 Invalid Clinical Laboratory Improvement Act Number(s).
I8 Invalid Entity Internal Report Reference.
I9 Invalid report type.
IC Insufficient credits available for transaction.
IN ITIN not allowed for this report type.
IP
Total Number of Claimants Included in (Global) Settlement was specified, but the payment was not
specified as being the result of a settlement. Total Number of Claimants Included in (Global) Settlement
is only allowed if the payment is the result of a settlement.
J1 Credit Card Issuer Unavailable: The NPDB experienced communication problems in contacting your
financial institution when we attempted to bill your account for the enclosed query. Since your financial
institution was not contacted, your account should not have been charged for this query. If, for any
reason, you are billed for the enclosed file, please contact the NPDB Customer Service Center
immediately at 1-800-767-6732. Please create a new query file for the subject name(s) in the enclosed
query file and transmit it to the NPDB. Should you add additional subject names to your new query,
your new charges will be higher than your original charge because fees are levied on a per-
name basis.
We regret any inconvenience that this may cause.
J2 Missing or invalid credit card information, the card holder name is missing or not valid.
J3 Missing or invalid credit card information, the credit card number is not a valid credit card number.
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J4 Missing or invalid credit card information, the credit card expiration date is not valid.
J5 All or part of the credit card billing address is missing or invalid.
J6 Payment information is missing.
J7 Invalid Credit card and EFT data conflict.
K1 Professional School information is not allowed in judgment or conviction reports.
K2 An Act or Omission Description is required if the Act or Omission Code is 999, and not allowed
otherwise.
K3 Invalid Case Number.
K4 Invalid Type of Action.
K5 Missing or invalid Docket/Court File Number.
K6 Missing or invalid Jurisdiction.
K7 Missing or invalid Narrative description of act(s) or omission(s).
K8 Missing or invalid Prosecuting Agency or Civil Plaintiff.
K9 Missing or invalid Venue information. Venue name, city and state are all required.
KA Invalid Investigating Agency Name.
KB Invalid Investigating Agency Case Number.
KC Invalid Other Organization Name.
KD
Hospital Affiliates are only valid for medical malpractice payment reports. Report this data in an Affiliate
record instead.
KE Type of Action on this correction or revision report must match the Type of Action of the previous report.
KF CLIA not allowed in organization judgment or conviction reports.
KG FDA not allowed in organization judgment or conviction reports.
M0 Specific allegation or date of event is missing or invalid, or description for an unclassified specific
allegation is missing.
M1 Missing or invalid Payment date. The date must be a valid date, must not be in the future, and must
occur after the date(s) of event(s) associated with the allegation(s) or incident(s).
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M2 Description of judgment or settlement is missing or invalid.
M3 Number of practitioners for whom this payer has paid or will pay in this case must be a value between 1
and 999 inclusive.
M4 State fund payment flag or amount is invalid.
M5 Self-insured payment flag or amount is invalid.
M6 Patient age, gender or type is missing or invalid.
M7 Description of the medical condition with which the patient presented for treatment is missing or invalid.
M8 Description of the procedure performed is missing or invalid.
M9 Nature of allegation code is missing or invalid.
MA Outcome is missing or invalid.
MB Description of allegations and injuries or illnesses is missing or invalid.
MC
Total amount paid or to be paid by this payer for this practitioner must be greater than or equal to the
amount of this payment by this payer for this practitioner.
MD Total amount paid or to be paid by this payer for all practitioners must be greater than or equal to total
amount paid or to be paid by this payer for this practitioner.
ME The NPDB no longer accepts initial Medical Malpractice Payment Reports in legacy format.
MF State fund payment flag and/or amount is invalid. Your entity's relationship to this practitioner (as
specified in this submission) does not allow the completion of the state fund payment fields.
MG
Self-insured payment flag or amount is invalid. Your entity's relationship to this practitioner (as specified
in this submission) does not allow the completion of the self-insured organization and/or other insurance
company payment fields.
MH Judgment or Settlement Date is invalid.
MI Invalid Total Number of Claimants Included in (Global) Settlement.
MJ Invalid Adjudicative Body Case Number.
MK Invalid Adjudicative Body Name.
ML Invalid Court File Number.
MM Missing or invalid Amount of This Payment for This Practitioner.
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Code Description
MN Missing or invalid Total Amount Paid or to Be Paid by This Payer for This Practitioner.
MO Total amount paid or to be paid by this payer for this practitioner must be greater than or equal to the
state fund payment amount.
MP Missing or invalid Total Amount Paid or to Be Paid by This Payer for All Practitioners.
MQ Total amount paid or to be paid by this payer for this practitioner must be greater than or equal to the
self-insured payment amount.
MR ITIN not allowed in medical malpractice payment reports.
MS Licensure Specialty not allowed in medical malpractice payment reports.
MT Organization Type not allowed in medical malpractice payment reports.
MU NPI not allowed in medical malpractice payment reports.
MV FEIN not allowed in medical malpractice payment reports.
MW UPIN not allowed in medical malpractice payment reports.
MX Only information regarding hospital affiliations may be reported for medical malpractice payment
reports.
MY The date of this payment should not be before 09/01/1990.
MZ Description of the Act(s) or Omission(s) and injuries or illnesses is missing or invalid.
P1 Missing or invalid customer subject ID number.
N0 A payment result of description must be provided if payment result of is “Other” and is not allowed
otherwise.
P2
Too many data elements have been changed in this enrollment update which may change the identity
of the subject and cause erroneous matching results.
P3 Missing or invalid enrollment purpose code.
P4 Missing or invalid cancellation purpose code.
P5 A cancellation purpose description must be provided if the cancellation purpose is "Other" and is not
allowed otherwise.
P6 Purpose code only allowed for enrollment transactions.
P7 Invalid number of subjects: Number of subjects does not match the number of subjects in the file.
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Code Description
P8 Data Bank subject ID number is not allowed for enrollment transactions.
P9 Data Bank subject ID number does not correspond to the same enrolled subject as the customer
subject ID number.
PA Data Bank subject ID number does not correspond to an active enrolled subject.
PB Data Bank subject ID number or customer subject ID number must be provided.
PC Customer subject ID number does not correspond to an active enrolled subject.
PD Subject is currently being enrolled or updated. Retry your submission after receiving output from the
enrollment or most recent update.
PE Enrolled subject can only be renewed within two months before or one month after its renewal date.
PF
The entity on whose behalf you are submitting this transaction has not enabled use of Continuous
Query.
PG Missing or invalid Data Bank subject ID number.
PH Only one Continuous Query update, cancellation or status request is allowed per submission file.
PI A maximum of 999 subjects may be submitted in a batch transaction.
PJ This Continuous Query renewal batch contains enrolled subjects with different expiration dates.
PM The Continuous Query subject is already up to date with the changes you submitted.
PN This enrollment contains subjects that match duplicate enrolled subjects: <name(s) and subject id(s) of
currently enrolled subject(s)>
Q1 Missing or invalid basis for finding.
Q4 Action taken date not allowed for this report type.
Q5 Action effective date not allowed for this report type.
Q6 Action length indefinite not allowed for this report type.
Q7 Action length permanent not allowed for this report type.
Q8 Action length not allowed for this report type.
Q9 Automatic reinstatement not allowed for this report type.
QA Amount not allowed for this report type.
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Code Description
QB Missing or invalid Type of Negative Finding code.
QC Missing or invalid negative finding description.
QD Missing or invalid negative finding date.
QE Missing or invalid basis for finding description.
QF Missing or invalid description of finding.
R1 All or part of certification information is missing.
R2 Invalid affiliate address.
R4 Invalid Organization Name.
R6 Invalid Customer Use data.
R9 You do not have the correct statutory authority to submit this report.
RE The DBID for your organization must be renewed before you can access the NPDB services. The
NPDB requires all registered entities to periodically renew their registration information. Re-registration
enables the NPDB to maintain accurate entity contact information and provides the entity with the
opportunity to review the legal requirements and verify their compliance for participation with NPDB.
The certifying official for your organization must review the NPDB regulations, available at
https://www.npdb.hrsa.gov/resources/aboutLegsAndRegs.jsp, as part of the renewal process. Once the
regulations have been reviewed, complete the on-line registration renewal form by logging in to the
IQRS and selecting Renew Registration on the registration confirmation screen. The completed form
must be signed and mailed to the NPDB for processing. If your organization has already mailed the
registration renewal to the NPDB, it will be processed within one business day of its receipt by the
NPDB. NPDB Correspondence will be sent once the NPDB has successfully processed your
registration renewal form. If necessary, you may complete a new form by selecting Renew Registration
below. If you need further assistance, please contact the NPDB Customer Service Center at 1-800-
767-6732.
RF
The DBID for your organization must be renewed before you can access the NPDB services. The
NPDB requires all registered entities to periodically renew their registration information. Re-registration
enables the NPDB to maintain accurate entity contact information and provides the entity with the
opportunity to review the legal requirements and verify their compliance for participation with NPDB.
The certifying official for your organization must review the NPDB regulations, available at
https://www.npdb.hrsa.gov/resources/aboutLegsAndRegs.jsp as part of the renewal process. Contact
the administrator of your organization so they can renew the registration. If you need further
assistance, please contact the NPDB Customer Service Center at 1-800-767-6732.
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Code Description
RG The DBID for the entity on whose behalf you are submitting the file must be renewed before the
submission file can be processed by the NPDB. The NPDB requires all registered entities to
periodically renew their registration information. Re-registration enables the NPDB to maintain accurate
entity contact information and provides the entity with the opportunity to review the legal requirements
and verify their compliance for participation with NPDB. As part of the renewal process, the certifying
official of the entity on whose behalf you are submitting the file must review the NPDB regulations,
available at https://www.npdb.hrsa.gov/resources/aboutLegsAndRegs.jsp. Once the certifying official
has reviewed these regulations, the entity administrator can complete the on-line registration renewal
form by logging in to the IQRS and selecting Renew Registration on the registration confirmation
screen. If you need further assistance, please contact the NPDB Customer Service Center at 1-800-
767-6732.
RH
File is not compliant with the current format version of the latest Interface Control Document (ICD).
Please review the appropriate ICD specification for the type of transaction you wish to submit and
update your ICD transaction files.
RI The administrator account can not be used to submit report or query transactions. These transactions
must be submitted using a user account.
RJ
The administrator account can not be used to submit query, report, or Continuous Query transactions.
These transactions must be submitted using a user account.
RQ Missing or invalid Void Reason Code.
RR Too much subject information has been changed. If you need to change subject information, first submit
a correction report and then submit this revision to action.
RS Missing or invalid void reason description.
RP The field of licensure (including the description, if provided) for the primary license must be a profession
that your board has stated it regulates. If this is the correct field of licensure, your Data Bank
administrator must first sign in to the IQRS and add the profession on the Regulated Professions
screen.
S0 The new password was based on a commonly used keyboard sequence. Passwords may not be a
simplistic or systematic sequence (e.g., abcd1234).
S1 The new password must be different from the old password.
S2 The new password must be between 15 and 64 characters long.
S3 The new password must contain at least one numeric character.
S4 The new password must contain at least one upper- and one lower-case character.
S5 The new password contains an illegal character.
S6 The new password was similar to your account user ID.
S7 The new password was similar to your account user ID with the characters reversed.
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S8 The new password was the same as one you used previously.
S9 The new password did not contain enough different characters.
SA The new password was similar to a word in the dictionary.
SB The new password was similar to a word in the dictionary with the characters reversed.
SC Missing or invalid user account in the password change or reset request.
SD Only the administrator may reset a user's account password.
SE You may not change another user's account password.
SF The administrator password cannot be reset. A password change request may be submitted instead.
SG The new password must be provided in the password change request.
SH The password must be omitted in the password reset request. The NPDB will generate a new
password.
SM Your password contains too many repeated characters.
SN You may only change your password once per day.
SO
Your password must contain at least one of these special characters: ! @ # $ ^ & * ( ) - _ = + [ ] { } | ; : , .
< > ?
SJ Reserved for future use.
UA URLs and references to external sites are not allowed in the description of allegations and injuries.
UF URLs and references to external sites are not allowed in the description of finding.
UJ URLs and references to external sites are not allowed in the description of the judgment or settlement.
UM URLs and references to external sites are not allowed in the description of the medical condition.
UN URLs and references to external sites are not allowed in the narrative description.
UP URLs and references to external sites are not allowed in the description of the procedure performed.
US URLs and references to external sites are not allowed in the narrative description of acts or omissions.
UZ URLs and references to external sites are not allowed in the description of acts or omissions.
V1 Missing or invalid Vendor ID.
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QRXS Client Program Status Codes
Table 209 - QRXS Client Program Status Codes
Code Description
C00 Success, no errors.
C01 Error on NPDB server, reattempt transfer.
C02 Authentication failed; DBID, UserID, or Password are invalid, or the user account is inactive.*
C03 Password expired for DBID and UserID.*
C04 No filenames specified for upload.
C05 Error sending files to server, reattempt transfer.
C06 Client sent an invalid request.
C07 Inactive DBID.
C08 Maximum upload file size exceeded; reduce file size and reattempt transfer.
C09 All uploaded files are invalid.
C10 Unable to communicate with NPDB server, reattempt transfer.
C12 Database error on NPDB server, reattempt transfer.
C13 Not all of the files were processed successfully.
C16 The DBID for your organization must be renewed before you can access the NPDB’s services.
The NPDB requires all registered entities to periodically renew their registration information.
Re-registration enables the NPDB to maintain accurate entity contact information and provides
the entity with the opportunity to review the legal requirements and verify their compliance for
participation with NPDB. The certifying official for your organization must review the NPDB
statutory authorities, available at https://www.npdb.hrsa.gov/resources/aboutLegsAndRegs.jsp,
as part of the renewal process. Once the statutory authorities have been reviewed, complete
the on-line registration renewal form by logging in to the IQRS and selecting Renew
Registration on the registration confirmation screen. The completed form must be signed and
mailed to the NPDB for processing. If your organization has already mailed the registration
renewal to the NPDB, it will be processed within 1 business day of its receipt by the NPDB.
NPDB Correspondence will be sent once the NPDB has successfully processed your
registration renewal form. If necessary, you may complete a new form by selecting Renew
Registration below. If you need further assistance, please contact the NPDB Customer Service
Center at 1-800-767-6732.
C17 The DBID for your organization must be renewed before you can access the NPDB’s services.
The NPDB requires all registered entities to periodically renew their registration information.
Re-registration enables the NPDB to maintain accurate entity contact information and provides
the entity with the opportunity to review the legal requirements and verify their compliance for
participation with NPDB. The certifying official for your organization must review the NPDB
statutory authorities, available at https://www.npdb.hrsa.gov/resources/aboutLegsAndRegs.jsp,
as part of the renewal process. Contact the Entity Data Bank Administrator of your organization
so they can renew the registration. If you need further assistance, please contact the NPDB
Customer Service Center at 1-800-767-6732.
C21 Client error, refer to log file for more information.
C22 Usage error, check command-line parameter.
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C23
Error in reading Initialization file qrxs.properties, check that qrxs.properties file is in working
directory.
C24 Unable to open program log file, check that disk space is available.
C30 Error validating property in qrxs.properties, a property is missing or value is invalid.
C31 Error validating UploadListFile, upload file missing or a file listed in the upload file does not
exist.
C32 Error validating DownloadDir, directory does not exist.
C40 Error opening connection to NPDB server, check Internet connection and reattempt transfer.
C43 Error during client startup.**
C54 Error downloading response files, reattempt transfer.
C56 Error getting the list of response files downloaded, reattempt transfer.
C57
Your password has expired. You may login to the IQRS to reset your password or contact your
Entity Data Bank Administrator or the NPDB Customer Service Center.***
C58 Your account has been locked out. Contact your Entity Data Bank Administrator to reset the
password. If you are using an Entity Data Bank Administrator account, contact the NPDB
Customer Service Center to reset the password.
C59
Your account has been locked out. The number of invalid login attempts has exceeded the
allowable login limit. Contact your Entity Data Bank Administrator to reset the password. If you
are using an Entity Data Bank Administrator account, contact the NPDB Customer Service
Center to reset the password.
C60 Your password must be changed before other transactions can be submitted.
C61 Error changing the password.
C62 Error resetting the password.
C64
No more than one password change transaction can be submitted at one time. Reduce the
number of password change transactions to one, reattempt transfer.
C68 To ensure account security, your Entity Data Bank Administrator must authorize this
connection.
C69
To ensure account security, the account holder must contact the NPDB Customer Service
Center at 1-800-767-6732 to access the system.
* F
or detailed information on maintaining User IDs and passwords refer to
https://www.npdb.hrsa.gov/hcorg/howToManageUserIdsAndPasswords.jsp.
** Either two instances of the client program are running or one instance of the program was terminated
prematurely. If it is the latter, remove the qrxslock file from the program’s working directory and try again.
*** Under specific circumstances the IQRS password reset service is available to obtain a new password. Log in
to the IQRS with your expired password to begin. You must have an e-mail address stored in your user account
to use this service. You may also contact your Entity Data Bank Administrator to reset the password. If you are
using an Entity Data Bank Administrator account, you may also use the IQRS password reset service or contact
the NPDB Customer Service Center to reset the password.
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QRXS Web Service Status Codes
Table 210 - QRXS Web Service Status Codes
Code Description
C00 Success, no errors.
C01 Error on NPDB server, reattempt transfer.
C02 Authentication failed; invalid DBID, UserID, or Password.*
C03 Password expired for DBID and UserID.*
C05 Error sending files to server, reattempt transfer.
C06 Client sent an invalid request.
C07 Inactive DBID.
C08 Maximum upload file size exceeded; reduce file size and reattempt transfer.
C09 All uploaded files are invalid.
C10 Unable to communicate with NPDB server, reattempt transfer.
C12 Database error on NPDB server, reattempt transfer.
C13 Not all of the files were processed successfully.
C16 The DBID for your organization must be renewed before you can access the NPDB’s services.
The NPDB requires all registered entities to periodically renew their registration information.
Re-registration enables the NPDB to maintain accurate entity contact information and provides
the entity with the opportunity to review the legal requirements and verify their compliance for
participation with NPDB. The certifying official for your organization must review the NPDB
statutory authorities, available at https://www.npdb.hrsa.gov/resources/aboutLegsAndRegs.jsp,
as part of the renewal process. Once the statutory authorities have been reviewed, complete
the on-line registration renewal form by logging in to the IQRS and selecting Renew Registration
on the registration confirmation screen. The completed form must be signed and mailed to the
NPDB for processing. If your organization has already mailed the registration renewal to the
NPDB, it will be processed within 1 business day of its receipt by the NPDB. NPDB
Correspondence will be sent once the NPDB has successfully processed your registration
renewal form. If necessary, you may complete a new form by selecting Renew Registration
below. If you need further assistance, please contact the NPDB Customer Service Center at 1-
800-767-6732.
C17 The DBID for your organization must be renewed before you can access the NPDB’s services.
The NPDB requires all registered entities to periodically renew their registration information.
Re-registration enables the NPDB to maintain accurate entity contact information and provides
the entity with the opportunity to review the legal requirements and verify their compliance for
participation with NPDB. The certifying official for your organization must review the NPDB
statutory authorities, available at https://www.npdb.hrsa.gov/resources/aboutLegsAndRegs.jsp,
as part of the renewal process. Contact the Entity Data Bank Administrator of your organization
so they can renew the registration. If you need further assistance, please contact the NPDB
Customer Service Center at 1-800-767-6732.
C40 Error opening connection to NPDB server, check Internet connection and reattempt transfer.
C54 Error downloading response files, reattempt transfer.
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Code Description
C57
Your password has expired. You may login to the IQRS to reset your password or contact your
Entity Data Bank Administrator or the NPDB Customer Service Center.***
C58 Your account has been locked out. Contact your Entity Data Bank Administrator to reset the
password. If you are using an Entity Data Bank Administrator account, contact the NPDB
Customer Service Center to reset the password.
C59
Your account has been locked out. The number of invalid login attempts has exceeded the
allowable login limit. Contact your Entity Data Bank Administrator to reset the password. If you
are using an Entity Data Bank Administrator account, contact the NPDB Customer Service
Center to reset the password.
C60 Your password must be changed before other transactions can be submitted.
C61 Error changing the password.
C62 Error resetting the password.
C64 No more than one password change transaction can be submitted at one time. Reduce the
number of password change transactions to one, reattempt transfer.
C68 To ensure account security, your Entity Data Bank Administrator must authorize this connection.
C69
To ensure account security, the account holder must contact the NPDB Customer Service
Center at 1-800-767-6732 to access the system.
*
For detailed information on maintaining User IDs and passwords refer to
https://www.npdb.hrsa.gov/hcorg/howToManageUserIdsAndPasswords.jsp.
*** Under specific circumstances the IQRS password reset service is available to obtain a new password. Log in
to the IQRS with your expired password to begin. You must have an e-mail address stored in your user account
to use this service. You may also contact your Entity Data Bank Administrator to reset the password. If you are
using an Entity Data Bank Administrator account, you may also use the IQRS password reset service or contact
the NPDB Customer Service Center to reset the password.
