FAQs
ABC Codes: Frequently Asked Questions
What are ABC codes?
ABC codes consist of a five-letter string (example AAAAA) followed by a two-character code modifier (1A). The string identifies the service, remedy, or supply item.
Has ABC Codes been tested in real-world use?
Yes. On January 16, 2003, the U.S. Department of Health and Human Services (HHS), under then-Secretary Tommy G. Thompson, granted an exception under HIPAA (45 CFR 162.940) so ABC codes could be tested in HIPAA standard code sets and electronic transactions. It was the first exception ever granted under that rule. HHS later extended the test, which ran from January 16, 2003 through October 16, 2006. During the enrollment periods, more than 10,000 organizations and individuals registered to use and evaluate ABC codes.
The company focused its data collection on two programs: a state Medicaid program and a Medicare Advantage program.
Alaska Medicaid
Alaska used ABC codes to fill gaps in its behavioral health program. In its 2006 letter, CMS acknowledged that the company "documented submission of 500,000 claims for 12 behavioral health codes in the Alaska Medicaid program." Each claim involves several HIPAA transactions: the claim itself (837), the payment advice (835), and often claim-status requests and responses (276/277). Together, those claims represent an estimated 1 to 2 million HIPAA transactions using ABC codes. In 2004 alone, the State reported processing "over 360,000 claims for outpatient mental health rehabilitation services that were billed using the ABC codes," serving more than 4,000 recipients. It also wrote that losing the codes "would cripple our current mental health system."
Bridges in Medicine
This integrative clinic and preferred provider network in Albuquerque, New Mexico, used ABC codes with a Medicare Advantage senior plan that grew to cover 21,000 Medicare-eligible members. Its physicians wrote that ABC codes let them "track and compare conventional versus integrative holistic protocols for quality of care as well as efficacy and cost of treatments."
Use today
CMS confirmed that outside HIPAA-covered transactions, "ABC codes can be freely used for all other purposes, and entities and practitioners not covered by HIPAA may use the ABC code set for any business purposes appropriate to their need."
Sources:
- ABC report to HHS, October 11, 2004. report
- CMS Office of E-Health Standards and Services letter, September 22, 2006. letter
- Letters of Support, abccodes.com. letters
- State of Alaska DHSS survey response, February 23, 2005. survey
What are code modifiers?
The code modifier identifies the practitioner type. For example, 1A identifies a Doctor of Chiropractic and 1K a Registered Nurse. ABC has mapped its practitioner modifiers to the Health Care Provider Taxonomy codes maintained by the National Uniform Claim Committee (NUCC), which payers may require on a claim.
What does "ABC codes" stand for?
"ABC codes" refers to an all-alphabetic coding system.
Are ABC codes only for alternative medicine?
No. Nurses of all levels use ABC codes, followed by behavioral and mental health practitioners, then physical and occupational therapists, holistic/functional/complementary care, indigenous healing practices and spiritual care.
Are ABC codes a HIPAA standard?
No. CPT and HCPCS remain the adopted HIPAA code sets. From January 16, 2003 through October 16, 2006, HHS allowed ABC codes to be tested in HIPAA standard transactions under an exception (45 CFR 162.940). Outside HIPAA-covered transactions, CMS confirmed that "ABC codes can be freely used for all other purposes, and entities and practitioners not covered by HIPAA may use the ABC code set for any business purposes appropriate to their need."
Do ABC codes replace CPT or HCPCS codes?
No. ABC codes currently supplement CPT and HCPCS codes to further detail the specific intervention being documented.
Who publishes and maintains ABC codes?
ABC Coding Solutions, Inc. publishes and maintains the ABC codes. The company was founded in 1996 (originally as Alternative Link, Inc.).
How many ABC codes are there?
Five-letter codes allow for over 11,000,000 total possible codes. We currently have 4,518 active codes (after adding chaplaincy codes).
Who uses ABC codes?
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Nurses, including registered nurses, nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists plus licensed practical/vocational nurses.
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Behavioral and mental health practitioners, such as psychologists, clinical social workers, licensed professional counselors, marriage and family therapists, and other behavioral health specialists.
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Physical and occupational therapists.
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Holistic care, indigenous healing practices and spiritual care, including spiritual care nurses and spiritual advisors of all faiths.
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Massage therapists
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Acupuncturists
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Chiropractors
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Nutritionists
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Naturopaths
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Naprapaths
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Reflexologists
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Herbologists
Where can I find the full code set?
The ABC Coding Manual (16th edition, 2021) includes the full code set except the chaplaincy care codes. Those codes start with the letter M (for example, MAAAA). They were first created for the MilSpirit project and were restored to the active code set after 2021 to support chaplaincy care.
Where can I look up an ABC code?
The ABC Coding Manual (16th edition, 2021) is available on the Products page at abccodes.com. Chaplaincy care codes added after 2021 are available from ABC Coding Solutions directly. For questions about a specific code, contact us through abccodes.com.
Do ABC codes guarantee payment or insurance coverage?
No. ABC codes identify services, remedies and supplies. Payment and coverage are decided by each payer.
Where is the official source for ABC code information?
The official source is abccodes.com.
I've seen other facts about ABC codes online. Are they accurate?
If a fact isn't on this page or on abccodes.com, don't treat it as confirmed.
Please contact ABC Coding Solutions if you have further questions.