Commercial/Other Insurance Coverage Type Codes

Commercial/Other Insurance Coverage Type Codes–Updated 10/04/19

www.Michigan.gov/MedicaidProviders Page 1 of 3

Provider Relations

Code Description Medical Pharmacy Dental Medicare Vision LTC

Mental

Health

AA

Medicare - Enrolled in Part A

N

Y

N

AS

All Services

Y

N

Y

N

BB

Medicare - Enrolled in Part B

N

Y

N

BV

Pharm, Vision, Mental Health, LTC

N

Y

N

Y

CC

Medicare - Enrolled in Medicare Advantage Plan

N

Y

N

DB

Dental, Mental Health, LTC

N

Y

N

Y

DD

Medicare - Enrolled in Part D

N

Y

N

DL

Med, Pharm, Dental and LTC

Y

N

Y

N

DM

Medical, Dental, and Mental Health

Y

N

Y

N

Y

DN

Dental, LTC

N

Y

N

Y

N

DO

Only Dental

N

Y

N

DP

Dental, Mental Health

N

Y

N

Y

DV

Only Dental and Vision

N

Y

N

Y

N

EL

Vision, LTC

N

Y

N

FR

Pharmacy, Dental, Vision

N

Y

N

Y

N

HD

Health Dental - Medical, Pharmacy and Dental

Only

Y

N

Y

HP

Medical, Pharmacy, Dental and Mental Health

(Excludes Vision and LTC)

Y

N

Y

HV

Health Vision - Medical, Pharmacy and Vision

Only

Y

N

Y

IO

Medical Only

Y

N

LD

Med, Dental, LTC

Y

N

Y

N

Y

N

LM

LTC, Mental Health

N

Y

Commercial/Other Insurance Coverage Type Codes–Updated 10/04/19

www.Michigan.gov/MedicaidProviders Page 2 of 3

Provider Relations

Code Description Medical Pharmacy Dental Medicare Vision LTC

Mental

Health

LP

Medical, Pharmacy, Vision, and LTC

Y

N

Y

N

M2

Exclude Rx and Medicare

Y

N

Y

N

Y

MD

Medical Dental - Medical and Dental Only

Y

N

Y

N

Y

MM

Medical, Vision and Mental Health

Y

N

Y

N

Y

MR

Medical RX - Medical and Pharmacy Only

Y

N

Y

MV

Medical Vision - Medical and Vision Only

Y

N

Y

ND

Medicare - Eligible, not enrolled in Medicare D

N

Y

N

NH

Only LTC Coverage

N

Y

N

NI

Pharm, Dental, Vision, LTC

N

Y

N

Y

N

NL

Pharm, Dental, Vision, Mental Health

N

Y

N

Y

N

Y

NM

No Medical

N

Y

N

Y

NR

Med, Dental, Vision, LTC

Y

N

Y

N

Y

N

PB

Pharm, LTC, Mental Health

N

Y

N

Y

PD

Pharm, Dental, LTC, Mental Health

N

Y

N

Y

PL

Medical, Pharmacy and LTC only

Y

N

Y

N

PM

Medical, Pharmacy, Vision and Mental Health

(Excludes Dental and LTC)

Y

N

Y

N

Y

PN

Pharmacy, LTC

N

Y

N

Y

N

PR

Exclude Psychiatric, RX, Dental, Vision

Y

N

Y

N

PS

Only Psych, Substance Abuse Treatment

N

Y

RD

RX Dental - Pharmacy and Dental Only

N

Y

N

RL

Pharm, Dental, LTC

N

Y

N

Y

N

RM

Pharm, Dental, Mental Health

N

Y

N

Y

RV

RX Vision - Pharmacy and Vision Only

N

Y

N

Y

N

RX

Only Pharmacy

N

Y

N

S3

Medical, Pharmacy, Dental, Vision and LTC

(Excludes Mental Health)

Y

N

Y

N

Commercial/Other Insurance Coverage Type Codes–Updated 10/04/19

www.Michigan.gov/MedicaidProviders Page 3 of 3

Provider Relations

Code Description Medical Pharmacy Dental Medicare Vision LTC

Mental

Health

S4

Standard 4 - Medical, Pharmacy, Dental and

Vision Only

Y

N

Y

SB

Dental, Vision, Mental Health, LTC

N

Y

N

Y

SL

Dental, Vision, LTC

N

Y

N

Y

N

SM

Dental, Vision, Mental Health

N

Y

N

Y

N

Y

VB

Vision, Mental Health, LTC

N

Y

VH

Pharmacy, Vision, Mental Health

N

Y

N

Y

N

Y

VL

Medical, Vision, LTC

Y

N

Y

N

VM

Vision, Mental Health

N

Y

N

Y

VN

Pharmacy, Vision, LTC

N

Y

N

Y

N

VO

Only Vision Care

N

Y

N

X1

Exclude Dental, Vision, Nursing Home

Y

N

Y

X2

Exclude Vision, Dental

Y

N

X3

Exclude RX, Vision

Y

N

Y

N

X4

Exclude RX, Dental

Y

N

Y

N

X5

Exclude RX, Vision, Dental

Y

N

Y

X6

Exclude Dental, RX, Nursing Home, Vision

Y

N

Y

XD

Exclude Dental

Y

N

Y

N

XL

Medical, Pharmacy, Dental, Vision and Mental

Health (Excludes LTC)

Y

N

Y

N

Y

XM

Medicare - Eligible for, not enrolled

N

Y

N

XN

Exclude Nursing Home, RX

Y

N

Y

N

Y

N

Y

XR

Exclude Pharmacy (RX)

Y

N

Y

N

Y

N

XV

Exclude Vision Care

Y

N

XX

Medicare - Aliens not enrolled for Medicare

N

Y

N