HealthCare Provider Taxonomy Codes Lookup

Updated on July 01, 2023. Version 23.1

Healthcare Taxonomy Codes are used for a variety of reasons which include specialization of health care providers, classification, and type. The Healthcare Taxonomy Set is designed in a hierarchical order that consists of definitions, descriptions, and codes.

The taxonomy code set is updated and published semi annually in January and July of each year. The January publication is available to be used in April and the July release is available to be used in October of that year. The implementation period is the elapsed time between the release date and the effective date. This time allows for vendors, payers, and providers the chance to incorporate all changes into their platforms and systems.

Exclusive Provider Organization - 302F00000X

(1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations.

Source: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 15; (2) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 58; (3) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.