--- kind: "section" citation: "45 C.F.R. § 162.1802" title: "45" number: "162.1802" heading: "Standards for coordination of benefits information transaction." url: "https://uscodex.org/cfr/45/162.1802" --- # §162.1802. Standards for coordination of benefits information transaction. The Secretary adopts the following standards for the coordination of benefits information transaction. - (a) **For the period from October 16, 2003 through March 16, 2009—** - (1) **Retail pharmacy drug claims.** The National Council for Prescription Drug Programs Telecommunication Standard Implementation Guide, Version 5, Release 1 (Version 5.1), September 1999, and equivalent NCPDP Batch Standard Batch Implementation Guide, Version 1, Release 1 (Version 1.1), January 2000, supporting Telecommunications Standard Implementation Guide, Version 5, Release 1 (Version 5.1) for the NCPDP Data Record in the Detail Data Record. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)). - (2) **Dental health care claims.** The ASC X12N 837—Health Care Claim: Dental, Version 4010, May 2000, Washington Publishing Company, 004010X097 and Addenda to Health Care Claim: Dental, Version 4010, October 2002, Washington Publishing Company, 004010X097A1. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)). - (3) **Professional health care claims.** The ASC X12N 837—Health Care Claim: Professional, Volumes 1 and 2, Version 4010, May 2000, Washington Publishing Company, 004010X098 and Addenda to Health Care Claim: Professional, Volumes 1 and 2, Version 4010, October 2002, Washington Publishing Company, 004010X098A1. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)). - (4) **Institutional health care claims.** The ASC X12N 837—Health Care Claim: Institutional, Volumes 1 and 2, Version 4010, May 2000, Washington Publishing Company, 004010X096 and Addenda to Health Care Claim: Institutional, Volumes 1 and 2, Version 4010, October 2002, Washington Publishing Company, 004010X096A1. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)). - (b) **For the period from March 17, 2009 through December 31, 2011, both—** - (1) The standards identified in [paragraph (a)](#a) of this section; and - (2) - (i) **Retail pharmacy drug claims.** The Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2007, and equivalent Batch Standard Implementation Guide, Version 1, Release 2 (Version 1.2), National Council for Prescription Drug Programs. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md).) - (ii) **The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—** Health Care Claim: Dental (837), May 2006, ASC X12N/005010X224, and Type 1 Errata to Health Care Claim: Dental (837), ASC X12 Standards for Electronic Date Interchange Technical Report Type 3, October 2007, ASC X12N/005010X224A1. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md).) - (iii) **The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—** Health Care Claim: Professional (837), May 2006, ASC X12N/005010X222. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md).) - (iv) **The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—** Health Care Claim: Institutional (837), May 2006, ASC X12N/005010X223, and Type 1 Errata to Health Care Claim: Institutional (837), ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, October 2007, ASC X12N/005010X223A1. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md).) - (c) For the period from January 1, 2012 through August 14, 2027, the standards identified in [paragraph (b)(2)](#b-2) of this section. - (d) For the period on and after September 21, 2020 through August 14, 2027, the Quantity Prescribed (460-ET) field, as set forth in the Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2007 and equivalent Batch Standard Implementation Guide, Version 1, Release 2 (Version 1.2), National Council for Prescription Drug Programs, must be treated as required where the transmission meets both of the following: - (1) Is for a Schedule II drug, as defined in [21 CFR 1308.12](/cfr/21/1308.12.md). - (2) **Uses the standard identified in paragraph (b)(2)(i) of this section.** - (e) **For the period from August 14, 2027 through April 14, 2028, both of the following—** - (1) **The standards identified in paragraphs (c) and (d) of this section.** - (2) **The following standards—** - (i) **Retail pharmacy drug claims.** The NCPDP Telecommunication Standard Implementation Guide Version F6, January 2020 and equivalent NCPDP Batch Standard Implementation Guide, Version 15, October 2017 (both incorporated by reference in [§ 162.920](/cfr/45/162.920.md)). - (ii) **Dental health care claims.** The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—Health Care Claim: Dental (837), May 2006, ASC X12N/005010X224, and Type 1 Errata to Health Care Claim: Dental (837) ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, October 2007, ASC X12N/005010X224A1 (both incorporated by reference in [§ 162.920](/cfr/45/162.920.md)). - (3) **Professional health care claims.** The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—Health Care Claim: Professional (837), May 2006, ASC X12N/005010X222 (incorporated by reference in [§ 162.920](/cfr/45/162.920.md)). - (4) **Institutional health care claims.** The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—Health Care Claim: Institutional (837), May 2006, ASC X12N/005010X223, and Type 1 Errata to Health Care Claim: Institutional (837) ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, October 2007, ASC X12N/005010X223A1 (incorporated by reference in [§ 162.920](/cfr/45/162.920.md)). - (f) For the period on and after April 14, 2028, the standards identified in [paragraph (e)(2)](#e-2) of this section. ## Notes ### Amendments [68 FR 8399, Feb. 20, 2003, as amended at 74 FR 3327, Jan. 16, 2009; 85 FR 4242, Jan. 24, 2020; 89 FR 100789, Dec. 13, 2024; 90 FR 40749, Aug. 21, 2025] ### Authority Authority: 42 U.S.C. 1320d—1320d-9 and secs. 1104 and 10109 of Pub. L. 111-148, 124 Stat. 146-154 and 915-917. ### Source Source: 65 FR 50367, Aug. 17, 2000, unless otherwise noted. ### Amendments [68 FR 8399, Feb. 20, 2003, as amended at 74 FR 3327, Jan. 16, 2009; 85 FR 4242, Jan. 24, 2020; 89 FR 100789, Dec. 13, 2024; 90 FR 40749, Aug. 21, 2025]