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(ASC X12) 1129 Adjustment Reason Code Characteristic


Specifies an additional characteristic of the adjustment reason


1 Primary Disability – Frozen
2 Primary Disability – Non-frozen
3 Dependent Disability – Frozen
4 Dependent Disability – Non-frozen
5 Retirement – Frozen
6 Retirement – Non-frozen
7 Permanent
8 Temporary
9 Canadian
15Defense Medical Evaluation
16Delayed Reporting Penalty (Insured)
17Engineering Services
18Expert Test (Trial)
19Expert Fees and Expenses (excluding tests and testimony)
22Fee Schedule Savings
24Permanent Total
25Permanent Total Supplemental
26Permanent Partial Scheduled
27Permanent Partial Unscheduled
28Temporary Total
29Temporary Partial
30Employer Liability
31Permanent Partial Disfigurement
32Employer Paid
34Funeral Expenses
37Employer’s Legal Expenses
38Claimant’s Legal Expenses
39Payments to Physicians
40Hospital Costs
41Other Medical
42Vocational Rehabilitation Evaluation
43Vocational Rehabilitation Education
44Other Vocational Rehabilitation
45Total Temporary Catastrophic
46Unknown Payment Type
57Vocational Rehabilitation Maintenance
58Claim Value Recovery
60Deductible Recovery
61Additional Living Expense
62Alternative Dispute Resolution Services
65Attorney Expenses
66Attorney Fees
67Auto Liability Subrogation
69Not Eligible
71Catastrophic Benefits
72Central Index Bureau Filing Fees
74Indemnity Reserves
75Medical Reserves
76Expense Reserves
77Vocational Rehabilitation Reserves
78Indemnity Payments
79Medical Payments
80Expense Payments
81Vocational Rehabilitation Payments
82Claim Payment
83Claim Reserve
84Bodily Injury Payment
85Bodily Injury Reserve
86Property Damage Payment
87Property Damage Reserve
88Comprehensive Payment
89Comprehensive Reserve
90Collision Payment
91Collision Reserve
93Expert Witness Fees
94Claimant Legal Expense
95Claimant Medical Evaluation
96Commercial Photographers
97Mandated Medical Exam
98Death Benefits
99Defense Attorney Fees and Expenses
A1Funeral Benefits
A2Hearing Attendance or Representation Fees
A3Hospital – Inpatient Charges
A4Hospital – Outpatient Charges
A5Hospital Bill Audit
A6Impairment Income Benefits
A7Independent Adjustor Expense
A8Independent Medical Exam
A9Legal Expenses – Miscellaneous
B1Liability Settlement
B2Life Pension
B3Lump Sum Remarriage Payment
B4Lump Sum Settlement Amount
B5Major Case of Individual Case Reporting
B6Medical Equipment
B7Peer Review Board Expenses
B8Medical Management Services
B9Medical Records or Reports
C1Medical Rehabilitation
C2Medical Test (Trial)
C3No-fault benefit or expense (Non-Workers Compensation)
C4Nursing Care
C5Extended Care Facility
C6State Fund – Other
C7Penalties Paid on Medical Benefits
C8Penalties Paid on Indemnity Benefits
C9Pension Indemnity Benefit
D1Permanent Partial Disfigurement
D2Personal Property or Contents
D4Photographs other than Commercial
D6PPO (Preferred Provider Organization) Fees or Expenses
D7Product Liability Subrogation
D8Property Adjustment
D9Provider Bill Audit Expense
E2Time and Expense Fees
E3Scheduled Award
E4Social Security
E5State Second Injury Fund
E6State Supplemental Fund
E7Supplemental Permanent Total Benefits
F1Testing Lab
F2Third Party Contribution
F3Transportation – Other
F4Transportation – Medical Treatment
F5Treating or Panel Physician
F6Utilization Review – Hospital
F7Utilization Review – Physician
F8Unallocated Indemnity
F9Unallocated Medical
G2Witness Fees and Expenses – Other than Expert Witness
G3Vocational Rehabilitation Training
G4Appraisal Fees
G5Autopsy Fees
G6Surveillance Special Investigation Fees and Expenses
G7Temporary Income Benefits
G8State Fund – Other
G9Federal Second Injury Fund
H2Federal Supplemental Fund
H3Flat Rate

Appears in

AD1Adjustment Amount
Review post

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