TUSS table: what it is and why it matters so much

The TUSS table (Unified Terminology for Supplementary Health) is the standard that organizes the language between hospitals, clinics and health plans in Brazil. Each procedure, test, appointment or material receives a unique code. When the hospital bills, it reports that code. When the payer receives it, it knows exactly what was performed.

Before TUSS, each provider used its own nomenclature. The payer interpreted it in its own way. This routine led to naming errors, payment delays and avoidable denials. Standardization solved part of this problem.

For the hospital manager, understanding TUSS means knowing where coding failures generate financial losses and how the correct use of codes protects billing.

How did the TUSS table come about?

TUSS was created jointly by the ANS (Brazil’s National Supplementary Health Agency), the AMB (Brazilian Medical Association) and COPISS (Committee for the Standardization of Supplementary Health Information). The terminology was established as the official standard by DIDES Normative Instruction No. 34 of February 13, 2009, which made its adoption mandatory for payers and providers of supplementary health services. Implementation was completed in October 2010.

The motivation was practical. Before TUSS, the same procedure could be described in dozens of different ways: “cranial MRI,” “MRI cranium,” “magnetic resonance imaging of the brain.” Each payer processed it in its own way, and any difference in nomenclature justified a denial or a payment delay.

With TUSS, there came to be a single code for each procedure. Free-text description gave way to a precise, traceable and auditable identifier. The table was structured based on the CBHPM hierarchy, which made the transition easier for the sector.

How does the TUSS table work in practice?

TUSS is organized into eight-digit numeric codes associated with standardized descriptions. Some examples:

• Medical appointment in a basic clinic: code 10101012

• Magnetic resonance imaging of the brain: code 41101014

• Appendectomy: code 31003079

When the hospital sends the claim to the health plan, it reports the TUSS code corresponding to each billed item. The payer identifies the procedure immediately, with no need for interpretation. Cross-checking what was performed, what was recorded and what was charged becomes straightforward.

This mechanism reduces room for ambiguity throughout the chain: front desk, billing, auditing and payment.

What are the categories of the TUSS table?

The table covers all supplementary health services, organized into four main chapters:

• General Procedures and Appointments: care by physicians and other health professionals in various specialties

• Clinical Procedures: diagnostic tests, clinical laboratory tests, imaging, biopsies and others

• Surgical and Invasive Procedures: surgeries of all sizes and specialties

• Diagnostic and Therapeutic Procedures: physical therapy, hemodialysis, radiation therapy, OPME (orthoses, prostheses and special materials) and others

This hierarchical organization, inherited from the CBHPM structure, makes it easier to find codes and to exercise internal control by service category.

TUSS and CBHPM: what is the difference?

The two tables coexist in hospital billing and have different functions. They are often confused, especially in surgical procedures, where both apply in a complementary way.

In practice: a surgical procedure uses the TUSS code to identify the act performed and the CBHPM to determine the surgical tier and the corresponding fees. Errors in either table can result in a denial.

What is the impact of TUSS on hospital billing?

The correct use of TUSS has a direct effect on hospital revenue in four dimensions:

Fewer denials due to nomenclature. Coding errors are among the most frequent causes of hospital claim denials. An incorrect or outdated code leads to rejection by the payer even when there is no clinical or care problem with the claim.

Faster payments. Claims sent with correct codes get through the payers’ audits more quickly: fewer questions, less time until payment.

Financial predictability. With standardized coding, the hospital estimates more accurately the amount to be received by type of procedure, which makes cash flow planning easier.

More efficient internal auditing. Checking what was performed against what was recorded becomes straightforward when both sides use the same reference.

A practical example: a hospital that wrote “cranial MRI” instead of using code 41101014 (magnetic resonance imaging of the brain) faced recurring denials due to differences in nomenclature. After standardizing the use of TUSS codes, denials for this reason were eliminated.

What are the challenges of applying the TUSS table?

Standardization solves the nomenclature problem, but correct application requires ongoing attention on four fronts:

Constant updates. The ANS periodically revises TUSS to incorporate new procedures and technologies. Outdated systems keep using revoked codes, generating avoidable denials.

Team training. Receptionists, billing specialists and auditors need to know the codes and when each one applies. Turnover in these roles makes ongoing training an operational necessity.

Systems integration. Hospital software without automatic ANS updates requires the files to be imported manually, which increases the risk of falling out of date.

OPME and special materials. The nomenclature for prostheses, orthoses and medical devices still raises frequent questions, especially in orthopedic and cardiovascular surgeries, where the financial impact of a denial is high.

How do you keep TUSS up to date at the institution?

Four practices reduce the risk of falling out of date:

1. Integration with systems that receive automatic ANS updates, eliminating dependence on manual imports.

2. Recurring training for billing and auditing teams, focused on the most recent versions of the table.

3. Periodic review of the highest-volume codes, especially after new versions are published.

4. Internal auditing of claims before they are sent to payers, identifying incorrect coding before it turns into denials.

To keep up with the latest changes, see: TUSS table update 2025: find out what changed.

Correct coding is the first line of defense against denials

TUSS solves the language problem. What it does not solve are the errors that happen before coding: incomplete clinical records, discrepancies between the medical record and the claim, or procedures performed without adequate documentation.

Rivio uses artificial intelligence to manage the entire hospital revenue cycle: it reads and interprets clinical records, cross-checks the information against each payer’s billing rules, identifies coding discrepancies before submission, automates XML submission and tracks denial appeals. With Rivio, hospitals leave the bureaucracy to AI and focus their energy on patient care.

FAQ — frequently asked questions about the TUSS table

What is the TUSS table?

TUSS (Unified Terminology for Supplementary Health) is the standard created by the ANS to standardize the names and codes of procedures, tests, appointments and materials in the relationship between hospitals, clinics and health plans. It was established by DIDES Normative Instruction No. 34/2009 and became mandatory in October 2010.

Does the TUSS table replace the CBHPM?

The two tables have different functions and coexist in billing. TUSS standardizes procedure terminology for billing and auditing purposes. The CBHPM defines the criteria for paying physician fees and surgical tiers. The structure of TUSS itself was built on the CBHPM hierarchy.

Are all providers required to use TUSS?

Yes. Its use is mandatory throughout supplementary health: hospitals, clinics, laboratories, outpatient services and health plans.

Does TUSS eliminate all billing errors?

TUSS eliminates nomenclature errors, which are among the most frequent causes of denials. Documentation errors, clinical errors or inadequate coding can still occur and require internal audit processes to be detected before submission to payers.

Where can I find the up-to-date TUSS table?

The table is available on the ANS portal and can be consulted free of charge. Hospital management software usually receives automatic updates; when it does not, the files must be imported directly from the agency’s website.