X12 Service Type Code Mapping
When working with the Solum Eligibility API, service types are returned as human-readable snake_case values (e.g., mental_health, physical_therapy). These map directly to the official X12 271 Eligibility Benefit Inquiry service type codes used in EDI transactions.
This reference shows how each X12 code translates to its Solum service_type value.
General & Plan-Level
| X12 Code | Solum Service Type | Description |
|---|
| 1 | medical_care | Medical Care |
| 9 | other_medical | Other Medical |
| 30 | health_benefit_plan_coverage | Health Benefit Plan Coverage |
| 32 | plan_waiting_period | Plan Waiting Period |
| 55 | major_medical | Major Medical |
| 60 | general_benefits | General Benefits |
Surgical
| X12 Code | Solum Service Type | Description |
|---|
| 2 | surgical | Surgical |
| 7 | anesthesia | Anesthesia |
| 8 | surgical_assistance | Surgical Assistance |
| 20 | second_surgical_opinion | Second Surgical Opinion |
| 21 | third_surgical_opinion | Third Surgical Opinion |
| 97 | anesthesiologist | Anesthesiologist |
| CC | surgical_benefits_professional | Surgical Benefits - Professional |
| CD | surgical_benefits_facility | Surgical Benefits - Facility |
Diagnostic & Lab
| X12 Code | Solum Service Type | Description |
|---|
| 4 | diagnostic_x_ray | Diagnostic X-Ray |
| 5 | diagnostic_lab | Diagnostic Lab |
| 62 | mri_cat_scan | MRI/CAT Scan |
| 66 | pathology | Pathology |
| 73 | diagnostic_medical | Diagnostic Medical |
| CK | screening_x_ray | Screening X-Ray |
| CL | screening_laboratory | Screening Laboratory |
| CM | mammogram_high_risk_patient | Mammogram - High Risk Patient |
| CN | mammogram_low_risk_patient | Mammogram - Low Risk Patient |
Hospital & Inpatient
| X12 Code | Solum Service Type | Description |
|---|
| 47 | hospital | Hospital |
| 48 | hospital_inpatient | Hospital - Inpatient |
| 49 | hospital_room_and_board | Hospital - Room and Board |
| 50 | hospital_outpatient | Hospital - Outpatient |
| 51 | hospital_emergency_accident | Hospital - Emergency Accident |
| 52 | hospital_emergency_medical | Hospital - Emergency Medical |
| 53 | hospital_ambulatory_surgical | Hospital - Ambulatory Surgical |
| 54 | long_term_care | Long Term Care |
| IC | intensive_care | Intensive Care |
| C1 | coronary_care | Coronary Care |
| UC | urgent_care | Urgent Care |
Mental Health & Behavioral
| X12 Code | Solum Service Type | Description |
|---|
| MH | mental_health | Mental Health |
| A4 | psychiatric | Psychiatric |
| A5 | psychiatric_room_and_board | Psychiatric - Room and Board |
| A6 | psychotherapy | Psychotherapy |
| A7 | psychiatric_inpatient | Psychiatric - Inpatient |
| A8 | psychiatric_outpatient | Psychiatric - Outpatient |
| BB | partial_hospitalization_psychiatric | Partial Hospitalization - Psychiatric |
| BC | day_care_psychiatric | Day Care - Psychiatric |
| BD | cognitive_therapy | Cognitive Therapy |
| CE | mental_health_provider_inpatient | Mental Health Provider - Inpatient |
| CF | mental_health_provider_outpatient | Mental Health Provider - Outpatient |
| CG | mental_health_facility_inpatient | Mental Health Facility - Inpatient |
| CH | mental_health_facility_outpatient | Mental Health Facility - Outpatient |
| RT | residential_psychiatric_treatment | Residential Psychiatric Treatment |
| 22 | social_work | Social Work |
Substance Abuse
| X12 Code | Solum Service Type | Description |
|---|
| AI | substance_abuse | Substance Abuse |
| AJ | alcoholism | Alcoholism |
| AK | drug_addiction | Drug Addiction |
| CI | substance_abuse_facility_inpatient | Substance Abuse Facility - Inpatient |
| CJ | substance_abuse_facility_outpatient | Substance Abuse Facility - Outpatient |
Rehabilitation & Therapy
| X12 Code | Solum Service Type | Description |
|---|
| PT | physical_therapy | Physical Therapy |
| AD | occupational_therapy | Occupational Therapy |
| AF | speech_therapy | Speech Therapy |
| AE | physical_medicine | Physical Medicine |
| BE | massage_therapy | Massage Therapy |
| A9 | rehabilitation | Rehabilitation |
| AA | rehabilitation_room_and_board | Rehabilitation - Room and Board |
| AB | rehabilitation_inpatient | Rehabilitation - Inpatient |
| AC | rehabilitation_outpatient | Rehabilitation - Outpatient |
| BF | pulmonary_rehabilitation | Pulmonary Rehabilitation |
| BG | cardiac_rehabilitation | Cardiac Rehabilitation |
Professional Visits
| X12 Code | Solum Service Type | Description |
|---|
| 3 | consultation | Consultation |
| 96 | professional_physician | Professional (Physician) |
| 98 | professional_visit_office | Professional Visit - Office |
| 99 | professional_visit_inpatient | Professional Visit - Inpatient |
| A0 | professional_visit_outpatient | Professional Visit - Outpatient |
| A1 | professional_visit_nursing_home | Professional Visit - Nursing Home |
| A2 | professional_visit_skilled_nursing_facility | Professional Visit - Skilled Nursing Facility |
| A3 | professional_visit_home | Professional Visit - Home |
| BY | physician_visit_office_sick | Physician Visit - Office (Sick) |
| BZ | physician_visit_office_well | Physician Visit - Office (Well) |
| 81 | routine_physical | Routine Physical |
| AQ | nonmedically_necessary_physical | Nonmedically Necessary Physical |
| BA | independent_medical_evaluation | Independent Medical Evaluation |
Preventive & Wellness
| X12 Code | Solum Service Type | Description |
|---|
| 17 | pre_admission_testing | Pre-Admission Testing |
| 19 | pneumonia_vaccine | Pneumonia Vaccine |
| 67 | smoking_cessation | Smoking Cessation |
| 68 | well_baby_care | Well Baby Care |
| 79 | allergy_testing | Allergy Testing |
| 80 | immunizations | Immunizations |
| CO | flu_vaccination | Flu Vaccination |
| GY | allergy | Allergy |
Maternity & Reproductive
| X12 Code | Solum Service Type | Description |
|---|
| 61 | in_vitro_fertilization | In Vitro Fertilization |
| 65 | newborn_care | Newborn Care |
| 69 | maternity | Maternity |
| 82 | family_planning | Family Planning |
| 83 | infertility | Infertility |
| 84 | abortion | Abortion |
| BT | gynecological | Gynecological |
| BU | obstetrical | Obstetrical |
| BV | obstetrical_gynecological | Obstetrical/Gynecological |
| BI | nursery | Nursery |
| NI | neonatal_intensive_care | Neonatal Intensive Care |
| TN | transitional_nursery_care | Transitional Nursery Care |
Dental
| X12 Code | Solum Service Type | Description |
|---|
| 23 | diagnostic_dental | Diagnostic Dental |
| 24 | periodontics | Periodontics |
| 25 | restorative | Restorative |
| 26 | endodontics | Endodontics |
| 27 | maxillofacial_prosthetics | Maxillofacial Prosthetics |
| 28 | adjunctive_dental_services | Adjunctive Dental Services |
| 33 | chiropractic | Chiropractic |
| 34 | chiropractic_office_visits | Chiropractic - Office Visits |
| 35 | dental_care | Dental Care |
| 36 | dental_crowns | Dental Crowns |
| 37 | dental_accident | Dental Accident |
| 38 | orthodontics | Orthodontics |
| 39 | prosthodontics | Prosthodontics |
| 40 | oral_surgery | Oral Surgery |
| 41 | routine_preventive_dental | Routine Preventive Dental |
Vision
| X12 Code | Solum Service Type | Description |
|---|
| AL | vision_optometry | Vision (Optometry) |
| AM | frames | Frames |
| AN | routine_exam | Routine Exam |
| AO | lenses | Lenses |
| BR | eye | Eye |
| CP | eyewear_and_accessories | Eyewear and Accessories |
Pharmacy & Prescriptions
| X12 Code | Solum Service Type | Description |
|---|
| 88 | pharmacy | Pharmacy |
| 89 | free_standing_prescription_drug | Free Standing Prescription Drug |
| 90 | mail_order_prescription_drug | Mail Order Prescription Drug |
| 91 | brand_name_prescription_drug | Brand Name Prescription Drug |
| 92 | generic_prescription_drug | Generic Prescription Drug |
| B2 | brand_name_prescription_drug_formulary | Brand Name Prescription Drug - Formulary |
| B3 | brand_name_prescription_drug_non_formulary | Brand Name Prescription Drug - Non-Formulary |
| BW | mail_order_prescription_drug_brand_name | Mail Order Prescription Drug - Brand Name |
| BX | mail_order_prescription_drug_generic | Mail Order Prescription Drug - Generic |
| GF | generic_prescription_drug_formulary | Generic Prescription Drug - Formulary |
| GN | generic_prescription_drug_non_formulary | Generic Prescription Drug - Non-Formulary |
| AR | experimental_drug_therapy | Experimental Drug Therapy |
DME & Supplies
| X12 Code | Solum Service Type | Description |
|---|
| DM | durable_medical_equipment | Durable Medical Equipment |
| 11 | used_durable_medical_equipment | Used Durable Medical Equipment |
| 12 | durable_medical_equipment_purchase | Durable Medical Equipment - Purchase |
| 18 | durable_medical_equipment_rental | Durable Medical Equipment - Rental |
| 75 | prosthetic_device | Prosthetic Device |
| DS | diabetic_supplies | Diabetic Supplies |
Home Health & Nursing
| X12 Code | Solum Service Type | Description |
|---|
| 42 | home_health_care | Home Health Care |
| 43 | home_health_prescriptions | Home Health Prescriptions |
| 44 | home_health_visits | Home Health Visits |
| 45 | hospice | Hospice |
| 46 | respite_care | Respite Care |
| 74 | private_duty_nursing | Private Duty Nursing |
| AG | skilled_nursing_care | Skilled Nursing Care |
| AH | skilled_nursing_care_room_and_board | Skilled Nursing Care - Room and Board |
| CA | private_duty_nursing_inpatient | Private Duty Nursing - Inpatient |
| CB | private_duty_nursing_home | Private Duty Nursing - Home |
Specialty Care
| X12 Code | Solum Service Type | Description |
|---|
| 6 | radiation_therapy | Radiation Therapy |
| 10 | blood_charges | Blood Charges |
| 64 | acupuncture | Acupuncture |
| 70 | transplants | Transplants |
| 71 | audiology_exam | Audiology Exam |
| 72 | inhalation_therapy | Inhalation Therapy |
| 77 | otological_exam | Otological Exam |
| 78 | chemotherapy | Chemotherapy |
| 85 | aids | AIDS |
| 86 | emergency_services | Emergency Services |
| 87 | cancer | Cancer |
| 93 | podiatry | Podiatry |
| 94 | podiatry_office_visits | Podiatry - Office Visits |
| 95 | podiatry_nursing_home_visits | Podiatry - Nursing Home Visits |
| B1 | burn_care | Burn Care |
| BH | pediatric | Pediatric |
| BJ | skin | Skin |
| BK | orthopedic | Orthopedic |
| BL | cardiac | Cardiac |
| BM | lymphatic | Lymphatic |
| BN | gastrointestinal | Gastrointestinal |
| BP | endocrine | Endocrine |
| BQ | neurology | Neurology |
| BS | invasive_procedures | Invasive Procedures |
| CQ | case_management | Case Management |
| DG | dermatology | Dermatology |
| ON | oncology | Oncology |
| PU | pulmonary | Pulmonary |
| RN | renal | Renal |
Renal & Dialysis
| X12 Code | Solum Service Type | Description |
|---|
| 14 | renal_supplies_in_home | Renal Supplies in Home |
| 15 | alternate_method_dialysis | Alternate Method Dialysis |
| 16 | chronic_renal_disease_equipment | Chronic Renal Disease Equipment |
| 76 | dialysis | Dialysis |
Transportation
| X12 Code | Solum Service Type | Description |
|---|
| 56 | medically_related_transportation | Medically Related Transportation |
| 57 | air_transportation | Air Transportation |
| 58 | cabulance | Cabulance |
| 59 | licensed_ambulance | Licensed Ambulance |
Transitional Care
| X12 Code | Solum Service Type | Description |
|---|
| 13 | ambulatory_service_center_facility | Ambulatory Service Center Facility |
| 63 | donor_procedures | Donor Procedures |
| TC | transitional_care | Transitional Care |
Usage in the API
Service types appear in eligibility check responses under extracted_data.services. Each entry includes the Solum service_type, the original X12 service_type_code, and per-network benefit details:
{
"extracted_data": {
"services": [
{
"service_type": "mental_health",
"service_type_code": "MH",
"copay_in_network": 25.0,
"copay_out_network": null,
"co_insurance_in_network": 20.0,
"co_insurance_out_network": 40.0,
"visit_limit_in_network": 52.0,
"visit_limit_out_network": null,
"visit_limit_remaining_in_network": 38.0,
"visit_limit_remaining_out_network": null,
"has_matching_benefits": true
},
{
"service_type": "physical_therapy",
"service_type_code": "PT",
"copay_in_network": 40.0,
"copay_out_network": null,
"co_insurance_in_network": null,
"co_insurance_out_network": null,
"visit_limit_in_network": 30.0,
"visit_limit_out_network": null,
"visit_limit_remaining_in_network": 18.0,
"visit_limit_remaining_out_network": null,
"has_matching_benefits": true
}
]
}
}
When an unknown X12 code is encountered during eligibility processing, Solum defaults to health_benefit_plan_coverage (code 30).
