Coverage Codes

Coverage Type Coverage Description
1 Hospital Inpatient Services
2 Hospital Outpatient Services
3 Hospital Inpatient / Outpatient Services
4 Physician Services
5 Physician Inpatient / Outpatient Services
6 Physician Inpatient / Outpatient Services & Major Medical
7 Dental Coverage
8 Vision Coverage
9 Drug Coverage
10 Physician Inpatient / Outpatient Services, Major Medical, & Dental
11 Physician Inpatient / Outpatient Services, Major Medical, & Vision
12 Physician Inpatient / Outpatient Services, Major Medical, & Drug (System
13 Medicare Supplement A & B
14 Indemnity Coverage (Payment To Client)
15 Major Medical
16 Major Medical / Physician
17 Major Medical / Physician / Dental
18 Major Medical / Physician / Vision
19 Major Medical / Physician / Drug
20 Major Medical / Physician / Dental / Vision/ Drug
21 Inpatient / Outpatient / Physician / Dental / Major Medical / Drug / Vision
22 Medicare Supplement Part A
23 Medicare Supplement Part B
24 Specialty Coverage (Cancer)
25 HMO
26 Nursing Home
27 Veterans Home
28 Worker's Compensation
29 Transplant Rider
30 Drug Script/Reg
40 DME
45 CHAMPUS Coverage
50 Absent Parent (4D)
60 HMO/Dental
61 HMO/Vision
62 HMO/Drug
63 HMO/Dental/Vision
64 HMO/Dental/Drug
65 HMO/Vision/Drug
66 HMO/Dental/Vision/Drug
70 Phys/Inpatient/Outpatient/Dental
71 Phys/Inpatient/Outpatient/Vision
72 Phys/Inpatient/Outpatient/Drug
73 Phys/Inpatient/Outpatient/Dental/Vision
74 Phys/Inpatient/Outpatient/Dental/Drug
75 Phys/Inpatient/Outpatient/Vision/Drug
76 Phys/Inpatient/Outpatient/Dental/Vision/Drug
77 Phys/Inpatient/Outpatient/Maj Med/Dental/Drug
78 Phys/Inpatient/Outpatient/Maj Med/Vision/Drug
90 Medicare Supplement A & B/Dental
91 Medicare Supplement A & B/Vision
92 Medicare Supplement A & B/Drug
93 Medicare Supplement A & B/Major Medical
99 Unknown
A1 Medicare A
A2 Medicare A HMO
B1 Medicare B
B2 Medicare B HMO
B3 Medicare B HMO/Dental
B4 Medicare B HMO/Vision
B5 Medicare B HMO/Drug
B6 Medicare B HMO/Dental/Vision
B7 Medicare B HMO/Dental/Drug
B8 Medicare B HMO/Vision/Drug
B9 Medicare B HMO/Dental/Vision/Drug

 

 

 

 

 

PDF All PDFs require the free Adobe Reader.

 

RI.giv

74 West Road | Cranston, RI 02920 | Contact Us | Directions
© RI.gov, Executive Office of Health & Human Services.
Sitemap | Privacy Policy

W3C