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Section 1 Introduction
- Introduction
- Federal Government Administration
- Fundamentals of Medicare: State Responsibilities
- Fundamentals of Medicare: Participating Providers
- Voluntary and Involuntary Termination of Provider Agreement
- Disclosure of Health Insurance Information
- Privacy Act
- National Provider Identifier
- Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)
- Medicare Administrative Contractors
- Fundamentals of Medicare: Information References
- Acronyms
- Fundamentals of Medicare: Glossary of Terms
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Section 2 Medicare Basics
- The History of Medicare
- What Is the Medicare Program and How Is It Funded?
- Medicare Eligibility and Premiums
- The Social Security Administration and Medicare Enrollment
- The Medicare Card
- Medicare Part A
- Inpatient Hospital Care
- Skilled Nursing Facility Inpatient Care
- Home Health Care Benefit
- The Hospice Benefit
- Medicare Part B Medical Insurance
- Fundamentals of Medicare - Medicare Program Exclusions
- Medicare Advantage Organizations
- Medicare Secondary Payer
- Supplemental Insurance
- Coordination of Benefits Trading Partners
- Section 3 Fraud and Abuse
- Section 4 Getting Ready to Bill Medicare
Section 1: Introduction
Legacy Provider Numbers/Provider Transaction Access Numbers
Table of Contents
- Legacy Provider Numbers/Provider Transaction Access Numbers
- State Code
- Facility Type
- Third-Digit Specialty Unit Designations
- Provider Number/PTAN Examples
Legacy Provider Numbers/Provider Transaction Access Numbers
With the implementation of the NPI in May 2008, legacy provider numbers are no longer issued. However, existing provider numbers are now known as PTANs. The following information on legacy numbers/PTANs is for educational purposes and describes how provider numbers/PTANs were derived. The provider number/PTAN is usually six digits in length, and assigned based on the type and location of the provider.
State Code
The first two digits in the provider number/PTAN indicate the state in which the provider or the provider’s main billing office is located. These first two digits are called the state code. For example, New York’s state code is 33, Connecticut’s state code is 07, and Indiana’s state code is 15. Some states with many providers can have two state codes. The full list of state codes can be found in the CMS IOM Publication 100-07, State Operations Manual, Chapter 2, Section 2779.
Facility Type
The remaining four digits indicate the type of facility. When the last four digits are all numbers, they are referred to as a “series.” Each type of facility is designated a specific series. As illustrated in the following chart, series 0001-0879 is reserved for short-term (general and specialty) hospitals, while 5000-6499 is reserved for skilled nursing facilities. Series that are not listed on the chart indicate retired series or series that are reserved for future use.
| Series | Type of Provider |
|---|---|
| 0001-0879 | Short-Term (General and Specialty) Hospitals |
| 0880-0899 | Reserved for hospitals participating in ORD demonstration project |
| 1225-1299 | Medical Assistance Facilities |
| 1300-1399 | Critical Access Hospitals |
| 1400-1499 | Continuation of Community Mental Health Centers Series |
| 1500-1799 | Hospices |
| 1800-1989 | Federally Qualified Health Centers |
| 1990-1999 | Religious Non-Medical Health Care Institutions |
| 2000-2299 | Long-Term Hospitals |
| 2300-2499 | Chronic Renal Disease Facilities (Hospital Based) |
| 2500-2899 | Non-Hospital Renal Disease Treatment Center |
| 2900-2999 | Independent Special Purpose Renal Dialysis Facility |
| 3025-3099 | Rehabilitation Hospitals |
| 3100-3199 | Continuation of Subunits of Nonprofit & Proprietary Home Health Agencies Series |
| 3200-3299 | Continuation of Comprehensive Outpatient Rehabilitation Facilities Series |
| 3300-3399 | Children’s Hospitals (Excluded from PPS) |
| 3400-3499 | Continuation of Rural Health Clinics (Provider-based) Series |
| 3500-3699 | Renal Disease Treatment Centers (Hospital Satellites) |
| 3700-3799 | Hospital Based Special Purpose Renal Dialysis Facility |
| 3800-3974 | Rural Health Clinics (Free standing) |
| 3975-3999 | Rural Health Clinics (Provider-Based) |
| 4000-4499 | Psychiatric Hospitals |
| 4500-4599 | Comprehensive Outpatient Rehabilitation Facilities |
| 4600-4799 | Community Mental Health Centers |
| 4800-4899 | Continuation of Comprehensive Outpatient Rehabilitation Facilities Series |
| 4900-4999 | Continuation of Community Mental Health Centers Series |
| 5000-6499 | Skilled Nursing Facilities |
| 6500-6989 | Outpatient Rehabilitation Facility (ORF) - Outpatient Physical Therapy (OPT) |
| 6990-6999 | Numbers Reserved (formerly Religious Nonmedical Health Care Institutions (RNHCI) Skilled Nursing Services) |
| 7000-7299 | Home Health Agencies |
| 7300-7399 | Subunits of “Nonprofit” and “Proprietary” Home Health Agencies |
| 7400-7799 | Continuation of Home Health Agencies Series |
| 7800-7999 | Subunits of State and Local Governmental Home Health Agencies |
| 8000-8499 | Continuation of Home Health Agencies Series |
| 8500-8899 | Continuation of Rural Health Clinics (Provider-Based) Series |
| 8900-8999 | Continuation of Rural Health Clinics (Free standing) Series |
| 9000-9799 | Continuation of Home Health Agencies Series |
Third-Digit Specialty Unit Designations
| 3rd Digit | Specialty Unit |
|---|---|
| M | CAH psychiatric unit |
| R | CAH rehabilitation unit |
| S | Psychiatric unit |
| T | Rehabilitation unit |
| U | Swing-Bed Hospital Designation for Short-Term Hospitals |
| W | Swing-Bed Hospital Designation for Long-Term Care Hospitals |
| Y | Swing-Bed Hospital Designation for Rehabilitation Hospitals |
| Z | Swing-Bed Designation for Critical Access Hospitals |
Provider Number/PTAN Examples
330XXX = Short-Term Hospital in New York
33TXXX = Rehabilitation Unit of a Short-Term Hospital in New York
0745XX = Comprehensive Outpatient Rehabilitation Facility in Connecticut
155XXX = Skilled Nursing Facility in Indiana
Reviewed 6/4/2024