Taxonomy Codes

The Healthcare Provider Taxonomy codes are a HIPAA standard code set named in the implementation specifications for some of the ASC X12N standard HIPAA transactions.

The Healthcare Provider Taxonomy Code (HPTC) is a situational data element in the ANSI X12N Implementation Guides for the 837 4010A1 Institutional and Professional claims or equivalent encounter information transactions. If the taxonomy code is required in order to properly pay or process a claim or equivalent encounter information transaction, it must be reported. Thus, reporting of the Healthcare Provider Taxonomy Code varies among health plans.

The Healthcare Provider Taxonomy Code set divides health care providers into hierarchical groupings by type, classification, and specialization, and assigns a code to each grouping. The Taxonomy code consists of two parts: individuals (such as physicians) and non-individuals (such asNextGen® Enterprise health care facilities). All codes are alphanumeric and are 10 characters in length. These codes are not assigned to health care providers; instead, health care providers select the taxonomy codes that most closely represent their education, license, certification, or specialty. A health plan may prefer that a health care provider who is associated with more than one taxonomy code use one code instead of another when the provider submits claims for certain services.

To meet HIPAA requirements, a Healthcare Provider Taxonomy Code may be required by some payers. Taxonomy codes are maintained at the Enterprise level in the Taxonomy master files and they can be attached to the provider in the Provider master file, locations in the Location master file, and to groups in the Group master file.