Use of the Technical Specifications, Resource Manual, and Value Sets for the Health Home Core Sets indicates acceptance of the following license agreements.
The American Medical Association (AMA), and the American Hospital Association (AHA) permit the use of Current Procedural Terminology (CPT), and National Uniform Billing Committee (NUBC) UB-04 codes solely for the purpose of reporting state data on Medicaid and CHIP Core Set measures to the Centers for Medicare & Medicaid Services (CMS).
The National Committee for Quality Assurance (NCQA permits the use of their technical specifications solely for the purpose of reporting state data on Medicaid and CHIP Core Set measures to the Centers for Medicare & Medicaid Services (CMS).
The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled “I accept”, you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement.
If you do not agree with all terms and conditions set forth herein, click below on the button labeled “I do not accept” and exit from this computer screen.
LICENSE FOR USE OF PHYSICIANS’ CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (“CPT”)
End User Point and Click Agreement: CPT codes, descriptions and other data only as contained in the following authorized materials used for reporting the Health Home Core Set are copyright 2023 American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).
You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt. Applicable FARS\DFARS Restrictions Apply to Government Use.
This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
AMA Disclaimer of Warranties and Liabilities.
This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, AMA Plaza, 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of FAR 52.227-14 (December 2007) and/or subject to the restricted rights provisions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Copyright Year Guideline: The AMA copyright year is 1 year earlier than the year of the CPT codebook. See Copyright Notices for specific year information.
CMS Disclaimer
The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.
LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)
American Hospital Association Copyright Notice
Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at (312) 893-6816.
Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816 or Laryssa Marshall at (312) 893-6814. You may also contact us at ub04@aha.org.
American Hospital Association Disclaimer
The American Hospital Association (“the AHA”) hasn’t reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.
NUBC UB-04 TERMS and CONDITIONS
1. Reproduction of Text: The reproduction of the UB-04 Manual will follow the text exactly.
2. Headings, Illustrations, or Captions: Make no changes to headings, illustrations, or captions.
3. No Deletions: Make no deletions without specific permission.
4. Reproduction Prohibitions and Limitations: The CMS user will not reproduce the entire NUBC UB-04 Specifications Manual, an entire chapter of the Specifications Manual, or any excerpt in excess of 10% of an entire chapter.
5. Copyright Notice: Any reproduced portion of the Specifications Manual will include the following copyright notice:
Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at (312) 893-6816
Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association.
To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816 or Laryssa Marshall at (312) 893-6814. You may also contact us at ub04@healthforum.com.
See AHA Exhibit 1 – NUBC UB-04 Copyright Notice
6. AHA disclaimer: Each document containing any portion of the Specifications Manual will include the following disclaimer is a prominent manner acceptable to the AHA:
The American Hospital Association ("the AHA") has not reviewed, and isn’t responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.
See AHA Exhibit 2 – NUBC UB-04 Disclaimer Language
7. Use Authorized: CMS may use the Licensed Data and Manual for training and educational purposes, claims review and validation, and hospital billing analysis along with other CMS Agency purposes only which shall be limited to responding to inquiries related to proper coding
8. NUBC UB-04 Specifications Data – Any Use Not Authorized is Prohibited
Any use not authorized is prohibited. Prohibitions include:
• Making copies of the Specifications Data for resale or licensing
• Transferring copies of the Specifications Data to any party not bound by the CMS-AHA data license agreement
• Creating modified or derivative works of the Specifications Data
• Making any commercial use of the Specifications Data
9. Use of the Specifications Data within the U.S.: The CMS user may use NUBC UB-04 data in programs administered by the Centers for Medicare & Medicaid Services within the U.S. and its territories.
10. Obscuring AHA Copyright: The CMS user shall not remove or obscure any AHA copyright notice or other proprietary rights notices included in AHA materials.
11. Rights Restrictions of DFAR: The CMS user acknowledges the Federal Acquisition Regulations (DFAR) restricts the U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation.
12. Disclaimer of Responsibility: The CMS user acknowledges the sole responsibility for NUBC UB04 Specifications Data is with CMS or its Medicare/Medicaid authorized agents. No endorsement by the AHA is intended or implied. The AHA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.
13. Questions about the Data License: The CMS user will submit AHA NUBC UB-04 use-related inquiries to the CMS CPT_CDT_NUBC_Mailbox.
14. Submitting the New Use Application
• The distribution of a CMS End-Product containing NUBC UB-04 codes, nomenclature, and descriptors that are unrelated to CMS programs requires a separate license agreement with the AHA.
• Additionally, new uses of the NUBC UB-04 Specifications Manual or Specifications Data require AHA approval.
See the CPT-CDT-NUBC New Use Application
• You will get an email acknowledging receipt of your application along with additional information on the application process.
15. CMS User’s Acceptance of the AHA Terms and Conditions: If you’re reviewing the above terms and conditions as a part of the AHA Point-and-Click Acceptance Agreement, use the close button to return to acceptance agreement. Next, select the accept button to generate an email with the hyperlink to the CDT electronic files.
FOR PROPRIETARY CODES:
Some measure specifications contain codding from LOINC® (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright © 1995-2023, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and available at no cost under the license at http://loinc.org/terms-of-use.
“SNOMED” and “SNOMED CT” are registered trademarks of the International Health Terminology Standards Development Organisation (IHTSDO).
“HL7” is the registered trademark of Health Level Seven International.
FOR NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) MEASURES:
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). The HEDIS measures and specifications are owned by NCQA. NCQA holds a copyright in these materials and may rescind or alter these materials at any time. Users of the HEDIS measures and specifications shall not have the right to alter, enhance or otherwise modify the HEDIS measures and specifications, and shall not disassemble, recompile, or reverse engineer the HEDIS measures and specifications. Anyone desiring to use or reproduce the materials without modification for the sole purpose of Health Homes Core Set reporting may do so without obtaining any approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using the measures and specifications with a product or service to calculate measure results), must be approved by NCQA and are subject to a license at the discretion of NCQA.
HEDIS measures and specifications are not clinical guidelines, do not establish a standard of medical care and have not been tested for all potential applications. The measures and specifications are provided “as is” without warranty of any kind. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of a HEDIS measure or specification. NCQA also makes no representations, warranties or endorsements about the quality of any organization or clinician who uses or reports performance measures. NCQA has no liability to anyone who relies on HEDIS measures and specifications or data reflective of performance under such measures and specifications.
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the specifications.
CPT® codes copyright 2023 American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/HHSARS restrictions apply to government use.
The American Hospital Association holds a copyright to the Uniform Billing Codes (“UB”) contained in the HEDIS Value Set Directory (VSD). The UB Codes are included with the permission of AHA. All uses of the UB Codes may require a license from the AHA. Specifically, anyone desiring to use the UB Codes in a commercial product to generate measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, please contact ub04@aha.org.
NCQA Measure Certification Notice:
A calculated measure result (a “rate”) from a HEDIS measure that has not been certified via NCQA’s Measure Certification Program, and is based on unadjusted HEDIS specifications, may not be called a “Health Plan HEDIS rate” until it is audited and designated reportable by an NCQA-Certified HEDIS Compliance Auditor. Until such time, such measure rates shall be designated or referred to as “Uncertified, Unaudited Health Plan HEDIS Rates.”
© 2023 by the National Committee for Quality Assurance, all rights reserved.
FOR THE CMS SCREENING FOR DEPRESSION AND FOLLOW-UP PLAN MEASURE:
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.
THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets.
CPT® contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC® is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms® (SNOMED CT®) copyright 2004- 2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved.
FOR THE AHRQ QUALITY INDICATOR MEASURE IN THE HEALTH HOME CORE SET:
The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators™ are products of the Federal government, and thus not covered by copyright within the United States. They are publicly available for noncommercial use or adaptation without further permission. However, foreign copyrights may apply, requiring written permission for use outside the U.S. Use of the trademark to identify the source of the AHRQ QIs should follow your organization’s editorial style. Please contact the AHRQ Office of Communications (Ask AHRQ (AHRQ/OC) AskAHRQ@ahrq.hhs.gov) for written permission regarding commercial use (e.g., reprinting in a professional journal or book; incorporation into commercial software; use in for-profit training courses).
FOR THE USE OF PHARMACOTHERAPY FOR OPIOID USE DISORDER MEASURE:
The Use of Pharmacotherapy for Opioid Use Disorder (OUD) measure is maintained by The Lewin Group for Centers for Medicare & Medicaid Services (CMS) Programs through the Home and Community-Based Services (HCBS) Measures Development, Endorsement, Maintenance, and Alignment contract HHSM-500-2014-00033I, Task Order 75FCMC19F0004.
For Proprietary Codes:
Limited proprietary coding is contained in the measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Lewin disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. Professional organizations frequently update their codes. Code lists for calculation of this measure were accurate as of October 2023.
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is published by the World Health Organization (WHO). ICD-10-CM is an official Health Insurance Portability and Accountability Act standard.
Level II HCPCS codes in these specifications are approved and maintained jointly by the Alpha-Numeric Panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association.)
The National Drug Code (NDC) Directory is published by the U.S. Food and Drug Administration and is made available under the Open Database License at http://opendatacommons.org/licenses/odbl/1.0/. Any rights in individual contents of the database are licensed under the Database Contents License at http://opendatacommons.org/licenses/dbcl/1.0/
SUMMARY
The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled “ACCEPT”. If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled “DO NOT ACCEPT” and exit from this computer screen.
