What a TUSS code is and how to identify it

TUSS stands for Terminologia Unificada da Saúde Suplementar (Unified Terminology for Supplementary Health). It is a set of codes and descriptions (the TUSS codes) created to standardize the way procedures, tests, consultations and other health services are identified and billed between hospitals, clinics and health plan payers.

Before TUSS, each payer and each provider used its own descriptions for similar services, which led to frequent inconsistencies in billing and auditing.

So, more than making it easier to fill in master data, the TUSS Table is strategic for avoiding charges denied by payers, discrepancies caused by different names for the same procedure and other errors that result in losses of millions for hospital management.

In this terminology, the TUSS code works as a unique identifier that describes exactly what was performed or requested, regardless of how the healthcare professional refers to the test or procedure.

TUSS code: why it is critical for healthcare billing

Although it often appears as just a number on medical orders, forms and hospital claims, the TUSS code is a decisive element in communication between service providers and health plan payers.

Using this code correctly reduces ambiguity, speeds up processes and contributes to the financial sustainability of healthcare institutions. When it is misapplied, it becomes one of the main causes of denials and rework in the revenue cycle.

The TUSS code is validated and updated periodically by the National Supplementary Health Agency (ANS). Adopting a unified terminology allowed hospitals, clinics, laboratories and health plans to operate on a common base of codes, reducing semantic and administrative discrepancies.

What is TUSS on a test order?

On a test order, the TUSS code objectively identifies which test the physician is requesting. This is particularly relevant for laboratory tests, where the same term may have technical or methodological variations.

For example, widely known tests such as the complete blood count, creatinine measurement or TSH have specific TUSS codes, defined according to the table’s official nomenclature.

Using the correct code on the order prevents the laboratory from interpreting the test differently from what the payer expects, reducing the risk of a refusal or a later denial.

The most common TUSS codes in care practice

Some tests account for a large volume of searches and recurring use in health services.

The TUSS code for the complete blood count is one of the most used in outpatient care, urgent care and hospital stays, since it is a general clinical assessment test. The complete blood count involves different hematological counts described individually in the TUSS table, for example:

• White blood cell count — 40304418 (leukocytes, count)

• Red blood cell count — 40319113 (Red blood cells, count)

The TUSS table groups these items under the set of tests that make up the complete blood count in billing.

The TUSS code for creatinine (40301630) is essential for tests related to kidney function and is widely used in hospitalized patients, in the follow-up of chronic diseases and in medication safety protocols.

In turn, TUSS code 40316521, for TSH (thyroid-stimulating hormone), is associated with assessing thyroid function and is frequently used in endocrinology, gynecology, internal medicine and preventive medicine.

Although these are common tests, errors in assigning the correct code are still frequent, especially when the table is updated or when contracts differ between payers.

How do you look up a TUSS code correctly?

TUSS codes should always be looked up in reliable, up-to-date sources. ANS publishes the official TUSS table, which undergoes periodic revisions to add, change or remove codes.

Beyond the official table, hospital management systems, laboratory software and billing platforms usually incorporate TUSS into their master data. However, it is essential to make sure these databases are synchronized with the current version, since using outdated codes can cause errors in hospital billing.

How do you find the correct TUSS code and avoid denials?

Identifying the correct TUSS code requires more than a simple search by test name. You need to understand the procedure’s technical description, its clinical purpose and its compatibility with the payer’s contractual rules.

In hospital routine, many errors occur when similar tests have different codes or when the same test can be billed in different ways, depending on the care context. The lack of this validation is one of the main causes of technical denials, even when the patient’s care was appropriate.

The Rivio view

While TUSS has brought more clarity to communication between hospitals and payers, manual processes are still prone to failure. This is where artificial intelligence (AI) becomes a powerful ally. Modern tools can already read and interpret clinical data, cross-check it against billing rules and identify nonconformities that could lead to denials.

Rivio is an artificial intelligence platform for healthcare management that handles the entire hospital revenue cycle.

Our technology analyzes clinical records, cross-checks information against hospital claims, identifies and corrects denials, submits the XML and manages denial appeals, all automatically. With Rivio, hospitals and clinics leave the paperwork to AI and can focus on what really matters: caring for the health of the Brazilian population.