Providers with a Primary and Secondary Specialty National Government Services

Every healthcare provider has at least one taxonomy code that reflects his or her specialty. Esure that your provider’s specialty is accurately represented by this. Medicare Part B providers are not required to report taxonomy codes on claims, however, National Government Services is urging providers to report taxonomy codes, for those providers who have both a primary and secondary specialty.

The Taxonomy Code Set, implemented in 2008, is a Health Insurance Portability and Accountability (HIPAA) standard code set and is the only code set that may be used in HIPAA standard transactions to report the type, classification, and/or specialization of a health care provider, when such reporting is required. The code set is updated twice a year, effective April 1 and October 1. The code set is maintained by the National Uniform Claim Committee.

Taxonomy codes are selected by the provider, when applying for a National Provider Identifier (NPI). When selecting two taxonomy codes, one must be chosen as primary.   The National Plan and Provider Eneumeration System (NPPES) does not verify the accuracy of the taxonomy code reported. NPPES only verifies that the code and description selections exist within the current version of the Healthcare Provider Taxonomy Code Set. It is the provider’s responsibility to ensure that the specialties chosen are accurate.

The Healthcare Provider Taxonomy Code or code description information, collected by NPPES, is used to help uniquely identify health care providers in order to assign them NPIs, not to ensure that they are credentialed or qualified to render health care.

Appropriate use of taxonomy codes will assist both the Medicare Administrative Contractor (MAC) and the provider. The use of Taxonomy Codes will allow MACs to aggregate data based on specialty practices. Information collected will provide more accurate comparisons of peer data reviews.