HCFA-1500 Box 10d - Claim Codes

On the HCFA-1500 form, Box 10d is labeled “Claim Codes (Designated by NUCC).” This field is used to report NUCC-approved Condition Codes when required by a payer or clearinghouse. These codes provide additional information about the claim—such as abortions, appeals, or special review circumstances—that may affect adjudication.

Providers should only complete Box 10d when explicitly instructed to do so. If required, enter valid Condition Codes from the NUCC-approved list. These codes are published under the “Code Sets” section at nucc.org.

When more than one condition code is necessary, separate each code with three blank spaces. The field allows a maximum of 19 characters.

Common NUCC Condition Codes include:

Abortion-Related Codes

• AA – Abortion Performed due to Rape
• AB – Abortion Performed due to Incest
• AC – Abortion Performed due to Serious Fetal Genetic Defect, Deformity, or Abnormality
• AD – Abortion Performed due to a Life Endangering Physical Condition Caused by, Arising from or Exacerbated by the Pregnancy Itself
• AE – Abortion Performed due to Physical Health of Mother that is not Life Endangering
• AF – Abortion Performed due to Emotional/Psychological Health of the Mother
• AG – Abortion Performed due to Social or Economic Reasons
• AH – Elective Abortion
• AI – Sterilization

Worker's Compensation & Appeals

• W2 – Duplicate of original bill
• W3 – Level 1 Appeal
• W4 – Level 2 Appeal
• W5 – Level 3 Appeal

In the X12 837 5010 format, data from Box 10d is typically reported in the HI segment of Loop 2300, using the BG qualifier (Condition Information). However, some trading partners may require the codes to appear elsewhere, so it’s important to confirm placement requirements with the payer.

Sample 837P (5010) – 2300 – HI Segment (Condition Code)

Note: The example above uses condition code W2, indicating a duplicate claim submission. If more than one condition code is needed, repeat the BG element within the same segment (e.g., HI*BG:W2*BG:W3~). Always ensure codes match the NUCC-approved list and confirm usage with your trading partner.

For additional information on the X12 837 standard, please refer to the official implementation guides published by X12.

HCFA-1500 Form Box Locations

• HCFA-1500 Box 0 - Carrier Block
• HCFA-1500 Box 1 - Insurance Type
• HCFA-1500 Box 1a - Insured's ID Number
• HCFA-1500 Box 2 - Patient's Name
• HCFA-1500 Box 3 - Patient's Birth Date and Sex
• HCFA-1500 Box 4 - Insured's Name
• HCFA-1500 Box 5 - Patient's Address
• HCFA-1500 Box 6 - Patient Relationship to Insured
• HCFA-1500 Box 7 - Insured's Address
• HCFA-1500 Box 8 - Reserved For NUCC Use
• HCFA-1500 Box 9 - Other Insured's Name
• HCFA-1500 Box 9a - Other Insured's Policy or Group Number
• HCFA-1500 Box 9b - Reserved For NUCC Use
• HCFA-1500 Box 9c - Reserved For NUCC Use
• HCFA-1500 Box 9d - Insurance Plan Name or Program Name
• HCFA-1500 Box 10 - Is Patient's Condition Related To
• HCFA-1500 Box 10d - Claim Codes [You are Here]
• HCFA-1500 Box 11 - Insured's Policy Group or FECA Number
• HCFA-1500 Box 11a - Insured's Date of Birth and Sex
• HCFA-1500 Box 11b - Other Claim ID
• HCFA-1500 Box 11c - Insurance Plan Name or Program Name
• HCFA-1500 Box 11d - Is There Another Health Plan
• HCFA-1500 Box 12 - Patient's or Authorized Person's Signature
• HCFA-1500 Box 13 - Insured's or Authorized Person's Signature
• HCFA-1500 Box 14 - Date of Current Illness, Injury, Pregnancy (LMP)
• HCFA-1500 Box 15 - Other Date
• HCFA-1500 Box 16 - Dates Patient Unable to Work in Current Occupation
• HCFA-1500 Box 17 - Name of Referring Provider or Other Source
• HCFA-1500 Box 17a - Other ID
• HCFA-1500 Box 17b - NPI
• HCFA-1500 Box 18 - Hospitalization Dates Related to Current Services
• HCFA-1500 Box 19 - Additional Claim Information
• HCFA-1500 Box 20 - Outside Lab Charges

Grab a sample of the HCFA-1500 claim form here - HCFA 02/12 Claim Form