> ## Documentation Index
> Fetch the complete documentation index at: https://docs.rcintell.com/llms.txt
> Use this file to discover all available pages before exploring further.

# L2: Facility type

> Resolve the payment system, billing form, and type of bill codes from the facility type encoded in a CCN

Layer 2 reads digits 3-4 of the CCN to determine the facility type, then resolves the applicable Medicare payment system, required billing form, and type of bill (TOB) codes. This determines *how* you bill — not just *what* you bill.

## How it works

```
CCN: 170001
        ^^
        00 → Short-Term Acute Care Hospital
```

The facility type code maps to a provider category, which in turn determines which prospective payment system applies and which claim form to use.

## Request

```bash theme={null}
curl https://api-dev.rcintell.com/v1/knowledge/layers/170001/l2 \
  -H "X-API-Key: $RCI_API_KEY"
```

## Response

```json theme={null}
{
  "layer": "l2_facility_type",
  "data": {
    "facility_type_key": "short_term_acute",
    "facility_type_name": "Short-Term Acute Care Hospital",
    "payment_system": "Inpatient Prospective Payment System (IPPS) / Outpatient Prospective Payment System (OPPS)",
    "inpatient_pps": "MS-DRG based",
    "outpatient_pps": "APC based",
    "billing_form": "UB-04 (CMS-1450) / 837I",
    "tob_inpatient": "011x",
    "tob_outpatient": "013x"
  }
}
```

## Facility type ranges

The facility type code (CCN digits 3-4) determines the provider category:

| Code range | Facility type                     | Payment system                        |
| ---------- | --------------------------------- | ------------------------------------- |
| 00-12      | Short-Term Acute Care Hospital    | IPPS (inpatient) / OPPS (outpatient)  |
| 13         | Critical Access Hospital (CAH)    | Cost-based (101% of reasonable costs) |
| 14-19      | Short-Term Acute Care Hospital    | IPPS / OPPS                           |
| 20-22      | Long-Term Care Hospital (LTCH)    | LTCH PPS (MS-LTC-DRG)                 |
| 30-39      | Home Health Agency                | HH PPS (PDGM, 30-day periods)         |
| 40-49      | Skilled Nursing Facility (SNF)    | SNF PPS (PDPM)                        |
| 50-64      | Rehabilitation Facility           | IRF PPS (Case-Mix Groups)             |
| 65-69      | Psychiatric Hospital              | IPF PPS                               |
| 70-79      | Federally Qualified Health Center | FQHC PPS                              |
| 80-89      | Hospice                           | Per-diem rates                        |

## Payment systems

Each facility type has a different Medicare payment methodology:

<CardGroup cols={2}>
  <Card title="IPPS / OPPS" icon="hospital">
    Short-term hospitals use MS-DRG (inpatient) or APC (outpatient) payment groups. The most common facility type.
  </Card>

  <Card title="Cost-based (CAH)" icon="house-medical">
    Critical Access Hospitals are reimbursed at 101% of reasonable costs — no DRG grouping.
  </Card>

  <Card title="HH PPS" icon="house-chimney-medical">
    Home health uses the Patient-Driven Groupings Model (PDGM) with 30-day payment periods and 432 case-mix groups.
  </Card>

  <Card title="SNF PPS" icon="bed">
    Skilled nursing uses the Patient-Driven Payment Model (PDPM) with consolidated billing — the SNF is responsible for almost all Part A and B services.
  </Card>
</CardGroup>

## Billing form rules

| Facility type        | Claim form       | Electronic format | When to use          |
| -------------------- | ---------------- | ----------------- | -------------------- |
| Hospital (all types) | UB-04 (CMS-1450) | 837I              | Institutional claims |
| Home Health          | UB-04 (CMS-1450) | 837I              | Episode claims, RAPs |
| SNF                  | UB-04 (CMS-1450) | 837I              | Consolidated billing |
| FQHC                 | UB-04 (CMS-1450) | 837I              | All-inclusive rate   |
| Physician (office)   | CMS-1500         | 837P              | Professional claims  |

<Note>
  Almost all facility types use the UB-04 / 837I for institutional claims. The CMS-1500 / 837P is used for professional claims billed by individual physicians, regardless of where the service was performed.
</Note>

## Type of bill codes

The TOB code is a 4-digit code on the UB-04 that identifies the type of facility, type of care, and billing frequency:

| Digit | Position | Meaning                                                         |
| ----- | -------- | --------------------------------------------------------------- |
| 0     | 1st      | Always 0 (leading zero)                                         |
| 1-8   | 2nd      | Facility type                                                   |
| 1-9   | 3rd      | Classification (inpatient, outpatient, etc.)                    |
| 0-9   | 4th      | Frequency (admit through discharge, interim, replacement, etc.) |

### Common TOB codes

| TOB  | Meaning                                  |
| ---- | ---------------------------------------- |
| 011x | Hospital inpatient (Part A)              |
| 013x | Hospital outpatient                      |
| 021x | SNF inpatient (Part A)                   |
| 0329 | Home health — not under PPS plan of care |
| 077x | FQHC                                     |
| 081x | Hospice (non-hospital based)             |
| 085x | CAH outpatient                           |

<Warning>
  Using the wrong TOB code is one of the most common reasons for claim rejections. Always use the TOB returned by the L2 layer for your facility type — don't assume based on the service alone.
</Warning>