The following list of revenue codes is taken from Chapter 421 of the Texas Administrative Code: The combined outpatient revenue codes under §421.67 and the hospital emergency department revenue codes under §421.77 are listed numerically below. Report the following information in the “Value Code” field: endstream endobj 753 0 obj <>/Outlines 19 0 R/Metadata 134 0 R/PieceInfo<>>>/Pages 133 0 R/PageLayout/OneColumn/OCProperties<>/OCGs[754 0 R]>>/StructTreeRoot 136 0 R/Type/Catalog/Lang(EN-US)/LastModified(D:20110725164149)/PageLabels 131 0 R>> endobj 754 0 obj <. To assist in bill review, the provider must list revenue codes in ascending numeric sequence and not repeat on the same bill Refer to the UB-04 manual for the valid codes. 0000003501 00000 n Revenue Code Description; 140: Room and board-semi private: 141: Medical/Surgical/Gyn-semi private: 142: OB-semi private: 143: Pediatric-semi private: 144: Psychiatric-semi private: 145: Hospice-semi private: 146: Detoxification-semi private: 147: Oncology-semi private: 148: Rehabilitation-semi private: 149: Other-semi private • Revenue codes 0450 to 0452, and 0459 are required, as are CPT codes 99284 and 99285. In short, Revenue Codes are descriptions and dollar amounts charged for hospital services provided to a patient. 6 Detoxification . 0000000016 00000 n 0 * To bill for room and board in a nursing facility when the beneficiary resides in a Facility Innovative Design Supplemental (FIDS) bed, use Revenue Code 0659. Each Physician service must be billed on a separate claim line. 0000001640 00000 n <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Code Description. 0000001918 00000 n Sterile environment is a room and board charge to be used by hospitals that are currently separating this charge for billing. 0000003004 00000 n ... 11X Room and Board- Private (Medical or General) 110 General. Subacute Rehabilitation (31 = NF Rehabilitation . • Room and board (private or semi-private room) • Durable medical equipment (DME), including specialized DME (e.g., Clinitron Bed, CPM) ... REVENUE CODE 120 Daily medical management and monitoring and skilled rehab services, pulmonologist available daily, Daily MD/NP/PA sees member daily, average length of stay is 25 days Charges for room and board should only include the time the patient was entitled to Part A. <]>> 9 Other . 0182 – Leave of Absence Days, Patient Convenience = Legacy BR codes 21, 22 & 24 3 Pediatric . HCPC (FISS Page 02) Enter the HCPC code 'A9270' on the 0659 revenue code line for room and board. 2 OB . <> 1 0 obj Attachment C - Valid Revenue Codes Revcode Description 1 Total Charge 100 All-Inclusive Room and Board Plus Ancillary 101 All-Inclusive Room and Board 110 Room & Board - Private(Medical or General) - General classification 111 Room & Board - Private(Medical or General) - Medical/Surgical/Gyn 112 Room & Board - Private(Medical or General) - OB RC 310X, Adult Care is effective April 1, 2003 all other new revenue codes are already in effect. … * To bill for room and board in a nursing facility when the beneficiary resides in a Facility Innovative Design Supplemental (FIDS) bed, use Revenue Code 0659. x��\[o��~7����R�\r�$��@,�N For example, if a claim is submitted for dates of service 8/1/2014 to 8/7/2014, then the room and board units should be 6 to exclude the day of discharge or death. UB-04 Revenue Codes for Providers-Numeric Listing 0001 Total Charges 0020 Health Insurance – Prospective Payment System (PPS) 0022 SNF – (PPS) 0023 Home Health – PPS 0024 Inpatient Rehab Facility – PPS 0100 All-inclusive Room & Board & Ancillary 0101 All-inclusive room & board 0110 Room & Board - Private 0111 Medical/surgical/gyn 0112 Obstetrics (OB) The revenue code tells an insurance company whether the procedure was performed in the emergency room, operating room … 0000003456 00000 n 4 0 obj UB04 Revenue Codes 0120 in section: 012X - Room & Board - Semi-private Two Beds (Medical or General) Thus, the adjacent charges entry in FL 47 is the sum of charges billed. trailer <>/Metadata 526 0 R/ViewerPreferences 527 0 R>> Legacy COS 082 – (Revenue Code 0942 and approved DT enrollment) Revenue Codes: 0110 - 0160 – Priced as General Room & Board = Legacy COS 073, 074 or 076 based on Taxonomy code . Per Methods 4.696: For isolation room, with PA , up to $35.00 for the difference between the facility's private pay private room and semi-private room … 0140 Room/Board—PVT Deluxe 3 1 Medical/surgical/gyn . Room and Board - Private. 5 Hospice . 752 0 obj <> endobj The rev codes are used for room and board. Quick Reference Guide-Occurrence Codes; Value Codes: Codes and related dollar amount that are necessity to process claims 837I, version 5010: Sequence of qualifier HI01=BE, HI01-2=value code, and Hi01-4=amount Quick Reference Billing Guide-Value Codes; Ancillary Services Use the following revenue codes and descriptions to bill LA ... 022 = Skilled Nursing Facility . Prospective Payment . System (RUGS) (88 = Case Mix -- Formerly LOC 20,21, 22) 118 = Room & Board-Private . 010X All Inclusive Rate UB04 Revenue Code. When a private room or deluxe private room is billed, recognized as revenue code 011X or 014X, and the hospital has both private and semi -private rooms available, then the hospital should report the semi - private room rate for the room type with value code … * Revenue Code 0657 Physician Services requires inclusion of a HCPCS code on the claim line. Publicly paid substance use disorder (SUD) treatment services may be delivered through either managed care or fee-for–service. Inpatient Room and Board Rate Reporting . 12X ROOM AND BOARD — SEMI-PRIVATE (MEDICAL OR GENERAL) General Classification Medical/Surgical/Gyn OB Pediatric Psychiatric Psychiatric Hospice (Not Covered) Detoxification ... Medical TransportThis Revenue Center Code must be used to bill for medical transportation OSTEOPATHIC SERVICES General Classification %%EOF Room & Board Revenue Code: must be a nursery room and board revenue code 170-179 **Note: Z38 ICD10 codes are not for use on the mother's claim. 0112 OB UB04 Revenue Code. 8 Rehabilitation . Revenue code 0110: Room and board - private room Remarks should reflect: private room rate minus semi-private room rate equals private room differential (e.g., $500 - $400 = $100) No condition code or value code 3 Pediatric . 4 0550 Skilled NursingPsychiatric . startxref 3 0 obj Claims without remarks may be returned to you. 0022 R&B - Medicare crossover only. 0000002446 00000 n 0130 Room/Board-SP 3-4 bd 1 Medical/surgical/gyn . Revenue Code only once during the month unless the LOC changes during the month. • ICD principal diagnosis codes are required for all services provided in an emergency room setting. 8 Rehabilitation . 0101 R&B - Custodial stay. Revenue Code only once during the month unless the LOC changes during the month. Unique 4 Digit Numbers. • Refer to contractual reimbursement terms to determine if billing is based on Skilled Nursing Facility (SNF) revenue codes or HIPPS RUG codes. 766 0 obj <>stream stream 752 15 Legacy COS 082 – (Revenue Code 0942 and approved DT enrollment) Revenue Codes: 0110 - 0160 – Priced as General Room & Board = Legacy COS 073, 074 or 076 based on Taxonomy code . * Revenue Code 0657 Physician Services requires inclusion of a HCPCS code on the claim line. 0144 Psychiatric PSYCH/DLX . Updated Nursing Facility Room and Board Revenue Codes Information for providers in the MyCare Ohio and Medicaid networks Effective July 1, 2018, Medicaid and MyCare Ohio claims must use the following revenue codes for reimbursement of nursing facility room & board. 0150 Room/Board—Ward 1 … include a new code for Type of Admission Form Locator (FL) 19 and new Revenue Codes (RC) in FL 42. 9 Other . Prospective Payment . Revenue Code Description CPT/HCPCS Code 0300 - 0309 Laboratory – Clinical Diagnostic Code for lab procedure performed 0310 - 0319 Laboratory - Pathology Code for pathology procedure performed ... A claim with an inpatient TOB must have room and board charges. 0146 Detoxification DETOX/DLX 0100 All-Inclusive Room and Board Plus Ancillary UB04 Revenue Code. • Bill each serviced ate as a separate line item. Subacute Rehabilitation (31 = NF Rehabilitation . 0000003227 00000 n ... 013x Room & Board - Three and Four Beds 75 014x Room & Board –Deluxe Private 76 015x Room & Board - Ward (Medical or General) 76 0115 Hospice/PVT 0125 Hospice/2Bed 0135 Hospice/3&4Bed 0145 Hospice/DLX 0155 Hospice/Ward 0167 Room and Board/ Self Care 0180 Leave of Absence or LOA 0182 Patient Convenience - Charges Billable 0183 Therapeutic Leave That’s where Revenue Codes come into play to help make the whole process smoother and universal. 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