NYSDOH
– NYS Medicaid License and Profession Code Table
This requirement applies to trading partners sending the ASC X12N 270,
278, and 837 transactions, and NCPDP 5.1 Telecommunications and 1.1
Batch requests.
Although using a License Number to identify a provider is supported, it is strongly recommended to use the NPI as the identifier for all providers who are eligible to receive an NPI, and a NYS Medicaid Provider ID to identify
Atypical Providers. All NPIs can be looked up at the NPPES at the following
URL: https://nppes.cms.hhs.gov/NPPES/Welcome.do
When using a License Number as a provider identifier for eMedNY,
NYSDOH requires a three-digit Profession Code as a prefix. The codes are a subset of the two-digit Profession Codes assigned by the New York State
Department of Education Office of the Professions (NYSED/OP) when it issues professional licenses. A leading zero is added to the left to create the NYSDOH three-digit Profession Code and, for NYS licensed providers, two more zeros must follow between the Profession Code and the License
Number. Exceptions exist for:
 using a license number to identify a NYS licensed Privileged Nurse
Practitioner or Privileged Midwife.
In these two cases a value of ‘0F’ must be inserted between the Profession Code and License Number instead of the two zeros.
 using a license number to identify a NYS licensed Optometrist or other eye-care practitioner with prescribing privileges. A value of
‘0V’, ‘0T’, or ‘0U’ - depending on the value on the NYS license - must be inserted between the Profession Code and License Number instead of the two zeros. This is not applicable to Ophthalmologists.
All out of state licenses must be formatted with the two-letter State, District of Columbia, or US Territory Code as assigned by the United States Postal
Service instead of the ‘00’, ‘0F’, ‘0V’, ‘0T’, or ‘0U’ values.
This formatting specification will allow the association of the provider on a claim with a provider reported on an X12 278 Prior Authorization in the
Requester Supplemental Identification and/or Service Provider
Supplemental Identification segment(s) using the ‘ZH’ qualifier.
When reporting the Prescriber ID in the NCPDP Prescriber Segment (a
Qualifier of ‘08’ is used), NYSDOH expects Provider Profession Code and
NYS Provider License Number. If an out of state License Number is used,
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NYSDOH
– NYS Medicaid License and Profession Code Table
NYS expects the NYS Provider Profession Code for out of state practitioners, a USPS State Code and the Provider License Number.
NYSED/OP also issues temporary limited permits for Physician’s
Assistants and Physicians who are not yet licensed. The limited permit numbers begin with a ’P’ followed by five digits. These permit numbers cannot be sent in electronic claims transactions. A supervising physician’s license or Provider ID must be sent instead, if the permit holder would otherwise be identified as the Rendering or Attending Provider.
The eMedNY system requires a three-digit Profession Code as a prefix to the
License Number for processing claims and other electronic healthcare transactions in which the license has been used to identify a provider.
The Profession Code is printed on the NYS license. Both the Profession Code and
License Number for all NYS licensed professionals are available from the NYS
Department of Education, Office of the Professions at the following URL: http://www.op.nysed.gov/opsearches.htm
The following table shows how to send the Profession Code and License Number for NYS Medicaid electronic healthcare transactions such as healthcare claims.
Using dummy values to represent the License Number, compound identifiers are created as examples (for out of state license examples, the District of Columbia abbreviation of “DC” is shown).
NYS
Dept. of Education
Profession Code
Profession Code Description
Compound Identifier for eMedNY
005
MENTAL HEALTH CREATIVE ARTS
THERAPY
00500123456
006
010
MENTAL HEALTH MARRIAGE AND
FAMILY THERAPY
PRACTICAL NURSE
00600123456
01000123456
018
019
022
020
MENTAL HEALTH COUNSELOR
PSYCHOANALYST
REGISTERED NURSE
PHARMACIST
01800123456
01900123456
02200123456
02000123456
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NYSDOH
– NYS Medicaid License and Profession Code Table
NYS
Dept. of Education
Profession Code
021
048
049
050
051
052
053
055
023
024
025
027
028
028
Profession Code Description
PHARMACIST LIMITED 3-YEAR
LICENSE
PHYSICIANS ASSISTANT
SPECIALIST ASSISTANT
ACUPUNCTURE
MASSAGE THERAPY
MIDWIFERY
MIDWIFERY WITH PRESCRIBING
PRIVILEGE
DIETETICS/NUTRITION
CERTIFIED DENTAL ASSISTANT
DENTIST
DENTIST HYGIENTIST
RESPIRATORY THERAPIST
RESPIRATORY THERAPY TECHNICIAN
OPTHALMIC DISPENSER
055
056
OPTHALMIC DISPENSER WITH
PRESCRIBING PRIVILEGE
OPTOMETRIST
056
OPTOMETRIST WITH PRESCRIBING
PRIVILEGE
Compound Identifier for eMedNY
057
058
059
060
061
062
063
064
065
066
067
AUDIOLOGY
SPEECH THERAPY
DENTAL SCHOOL
PHYSICIAN - MEDICINE &
OSTEOPATHY
MEDICINE – LIMITED PRACTICE
PHYSICAL THERAPIST
OCCUPATIONAL THERAPIST
OCCUPATIONAL THERAPIST
ASSISTANT
PODIATRIST
PHYSICAL THERAPIST ASSISTANT
ATHLETIC TRAINER
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02100123456
02300123456
02400123456
02500123456
02700123456
02800123456
028 0F 123456
04800123456
04900123456
05000123456
05100123456
05200123456
05300123456
05500123456
055 0V 123456
- or -
055 0U 123456
05600123456
056 0V 123456
- or -
056 0U 123456
- or -
056 0T 123456
05700123456
05800123456
05900123456
06000123456
06100123456
06200123456
06300123456
06400123456
06500123456
06600123456
06700123456

NYSDOH
– NYS Medicaid License and Profession Code Table
NYS
Dept. of Education
Profession Code
068
070
072
Profession Code Description
PSYCHOLOGIST
CHIROPRACTOR/PORT XRAY
SVC(QMB)
LICENSED MASTER SOCIAL WORKER
073
081
082
083
088
089
LICENSED CLINICAL SOCIAL WORKER
DENTAL PARENTERAL CONSCIOUS
SEDATION
DENTAL GENERAL ANESTHESIA
DENTAL ENTERAL CONSCIOUS
DENTAL PARENTERAL CONSCIOUS
SEDATION
DENTAL ANESTHESIA
Compound Identifier for eMedNY
06800123456
07000123456
07200123456
07300123456
08100123456
08200123456
08300123456
08800123456
08900123456
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NYSDOH
– NYS Medicaid License and Profession Code Table
Profession Code
005
006
010
018
019
022
020
023
024
025
027
028
048
049
050
051
052
053
055
056
057
058
059
060
062
063
064
065
066
Profession Code Description for
Out of State licenses
OUT OF STATE MENTAL HEALTH
CREATIVE ARTS THERAPY
OUT OF STATE MENTAL HEALTH
MARRIAGE AND FAMILY THERAPY
OUT OF STATE PRACTICAL NURSE
OUT OF STATE MENTAL HEALTH
COUNSELOR
OUT OF STATE PSYCHOANALYST
OUT OF STATE REGISTERED NURSE
OUT OF STATE PHARMACIST
OUT OF STATE PHYSICIANS ASSISTANT
OUT OF STATE SPECIALIST ASSISTANT
OUT OF STATE ACUPUNCTURE
OUT OF STATE MASSAGE THERAPY
OUT OF STATE MIDWIFERY
OUT OF STATE DIETETICS/NUTRITION
OUT OF STATE CERTIFIED DENTAL
ASSISTANT
OUT OF STATE DENTIST
OUT OF STATE DENTIST HYGIENTIST
OUT OF STATE RESPIRATORY
THERAPIST
OUT OF STATE RESPIRATORY
THERAPY TECHNICIAN
OUT OF STATE OPTHALMIC DISPENSER
OUT OF STATE OPTOMETRIST
OUT OF STATE AUDIOLOGY
OUT OF STATE SPEECH THERAPY
OUT OF STATE DENTAL SCHOOL
OUT OF STATE PHYSICIAN - MEDICINE
& OSTEOPATHY
OUT OF STATE PHYSICAL THERAPIST
OUT OF STATE OCCUPATIONAL
THERAPIST
OUT OF STATE OCCUPATIONAL
THERAPIST ASSISTANT
OUT OF STATE PODIATRIST
OUT OF STATE PHYSICAL THERAPIST
ASSISTANT
Compound Identifier for eMedNY
(All out of state examples show a license from the District of
Columbia)
005 DC 123456
006 DC 123456
010 DC 123456
018 DC 123456
019 DC 123456
022 DC 123456
020 DC 123456
023 DC 123456
024 DC 123456
025 DC 123456
027 DC 123456
028 DC 123456
048 DC 123456
049 DC 123456
050 DC 123456
051 DC 123456
052 DC 123456
053 DC 123456
055 DC 123456
056 DC 123456
057 DC 123456
058 DC 123456
059 DC 123456
060 DC 123456
062 DC 123456
063 DC 123456
064 DC 123456
065 DC 123456
066 DC 123456
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NYSDOH
– NYS Medicaid License and Profession Code Table
Profession Code
067
068
070
073
081
082
083
088
089
Profession Code Description for
Out of State licenses
OUT OF STATE ATHLETIC TRAINER
OUT OF STATE PSYCHOLOGIST
OUT OF STATE CHIROPRACTOR/PORT
XRAY SVC(QMB)
OUT OF STATE LICENSED CLINICAL
SOCIAL WORKER
OUT OF STATE DENTAL PARENTERAL
CONSCIOUS SEDATION
OUT OF STATE DENTAL GENERAL
ANESTHESIA
OUT OF STATE DENTAL ENTERAL
CONSCIOUS
OUT OF STATE DENTAL PARENTERAL
CONSCIOUS SEDATION
OUT OF STATE DENTAL ANESTHESIA
Compound Identifier for eMedNY
(All out of state examples show a license from the District of
Columbia)
067 DC 123456
068 DC 123456
070 DC 123456
073 DC 123456
081 DC 123456
082 DC 123456
083 DC 123456
088 DC 123456
089 DC 123456
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NYSDOH
– NYS Medicaid License and Profession Code Table
Licenses for NYS Nurse Practitioners include the Profession Code as the first two digits of the License Number. There are seventeen NYS-licensed areas of Nurse
Practitioner specialization. The specification does not change for these providers, other than the requirement to insert a value of ‘0F’ between the Profession Code and License Number for services rendered by a Privileged Nurse Practitioner
(those with prescribing privilege).
NYSDOH
Profession Code
Profession Code Description
Compound Identifier for eMedNY
030
NURSE PRACTITIONER – ADULT
HEALTH
03000301234
030
031
031
032
032
033
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE – ADULT
HEALTH
NURSE PRACTITIONER – COLLEGE
HEALTH
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE – COLLEGE
HEALTH
NURSE PRACTITIONER – COMMUNITY
HEALTH
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
COMMUNITY HEALTH
NURSE PRACTITIONER – FAMILY
HEALTH
030 0F 301234
03100311234
031 0F 311234
03200321234
032 0F 321234
03300331234
033
034
034
035
035
036
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE – FAMILY
HEALTH
NURSE PRACTITIONER –
GERONTOLOGY
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
GERONTOLOGY
NURSE PRACTITIONER –
NEONATOLOGY
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
NEONATOLOGY
NURSE PRACTITIONER –
OBSTETRICS & GYNECOLOGY
033 0F 331234
03400341234
034 0F 341234
03500351234
035 0F 351234
03600361234
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NYSDOH
– NYS Medicaid License and Profession Code Table
NYSDOH
Profession Code
036
037
037
038
038
039
039
040
040
041
041
042
042
043
043
044
044
045
Profession Code Description
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
OBSTETRICS & GYNECOLOGY
NURSE PRACTITIONER – ONCOLOGY
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
ONCOLOGY
NURSE PRACTITIONER – PEDIATRICS
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
PEDIATRICS
NURSE PRACTITIONER –
PERINATOLOGY
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
PERINATOLOGY
NURSE PRACTITIONER –
PSYCHIATRY
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
PSYCHIATRY
NURSE PRACTITIONER – SCHOOL
HEALTH
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE – SCHOOL
HEALTH
NURSE PRACTITIONER – WOMEN’S
HEALTH
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE – WOMEN’S
HEALTH
NURSE PRACTITIONER – ACUTE
CARE
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE – ACUTE
CARE
NURSE PRACTITIONER – PALLIATIVE
CARE
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
PALLIATIVE CARE
NURSE PRACTITIONER – HOLISTIC
CARE
Compound Identifier for eMedNY
036 0F 361234
03700371234
037 0F 371234
03800381234
038 0F 381234
03900391234
039 0F 391234
04000401234
040 0F 401234
04100411234
041 0F 411234
04200421234
042 0F 421234
04300431234
043 0F 431234
04400441234
044 0F 441234
04500451234
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NYSDOH
– NYS Medicaid License and Profession Code Table
NYSDOH
Profession Code
Profession Code Description
045
046
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE – HOLISTIC
CARE
NURSE PRACTITIONER –
ANESTHESIA
046
NURSE PRACTITIONER WITH
PRESCRIBING PRIVILEGE –
ANESTHESIA
Modified: October 25, 2011
Compound Identifier for eMedNY
045
04600461234
046
0F 451234
0F 461234
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