What is the list of revenue codes for medical billing that you can count on right now? 20? 30? Or at least 10? Oh yeah, Not so possible to reveal it right now! Then how do you memorize it? Fine, that’s not simple either. Medical coding has been a complex process always. Whenever a new code pops in, it becomes challenging for professionals to figure out the actual place to use them and whether they should add the codes along with any modifiers. The list of revenue codes for medical billing, no doubt, will help make the process smoother and easier or less complicated.

People new to this area might wonder the difference between revenue codes and the others. Revenue codes are used in hospital billing. The list of revenue codes for medical billing conveys to the insurance payer either where the patient was or when they received treatment or what type of equipment a patient might have received. If this goes missing from the claim, then the provider has to forget about his reimbursement. These codes also reveal if the procedure was performed in an operation theatre, emergency room, or another place.

This article brings you a detailed study on the list of revenue codes for medical billing, which is necessary to enhance your business profits.

Understanding the list of revenue codes for medical billing:

  • Alright! Getting into the basics of revenue codes, you can use these 4-digit codes on hospital bills to convey or reveal to insurance payers where the patient existed while receiving the treatment.
  • It also includes the type of equipment or item that the patient has received during the procedure.
  • However, hospitals run on three different codes. They include:
  1. ICD-10: for diagnoses
  2. CPT: for procedures
  3. HCPCS: for medical goods and services.
  • When the list of revenue codes for medical billing is attached to the supply codes, they identify if the equipment was used in the hospital or taken home by a patient.
  • This is extremely important because most of the procedures performed in the hospitals are done in different areas.
  • For instance, the stitches are done in an emergency room or other designated area in the hospital, such as the maternity ward.
  • Of course, it depends on the procedure performed, and the price for the procedure can be entirely different too!

Revenue codes on UB-04:

  • The list of revenue codes for medical billing is located in various areas on UB-04 forms. UB-04 is the billing form used by hospitals and other healthcare professionals.
  • The significant purpose of these codes is to group similar charges onto one line in the form.
  • Please keep in mind that you cannot report revenue codes on a CMS-1500 form but can report them on a UB-04.
  • So, for those insurance companies, for whom UB-04 forms are submitted, you can reveal your charges and bill for few ancillary services, like supplies.
  • A valid procedure code should be accompanied by a revenue code so that the insurance companies accept it.
  • There are almost 81 fields in the UB-04 form, and revenue codes are located by fields 42-49 (FL42-49).
  • This list of revenue codes for medical billing companies was developed for the Medicare system but soon were adopted as standard codes for the hospitals and healthcare organizations.
  • Revenue codes have to go along with the procedure codes. While arranging them in the chargemaster, you probably should add the correct revenue code to the CPT code you were going to use for a particular department.
  • It is the use of revenue codes that allow hospitals to use the same CPT code in multiple departments as it shows which department the services were rendered to the patient.

List of revenue codes for medical billing:

0001: Total Charges

001X: Reserved for internal payer use

002X: Health Insurance Prospective Payment System (HIPPS)

0020-0021 Reserved

0022 – Skilled Nursing Facility (SNF) PPS

0023 – Home Health PPS

0024 – Inpatient Rehabilitation Facility (IRF) PPS

0025-0029 – Reserved

  • Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets of patient characteristics, and healthcare insurance payers use them to make payment determinations under several prospective payment systems.
  • These revenue codes mentioned above include reserved skilled nursing facility, home health PPS, and inpatient rehabilitation facility.
  • These HIPPS codes are mentioned or reported on the claims to the insurance companies.

010X

All-inclusive Rate

0100: All-inclusive room and Board plus ancillary

0101: All-inclusive Room and Board

011X

Room and Board Private (one bed)

0110:  General

0111: Medical/Surgical/GYN

0112: OB

0113: Pediatric

0114: Psychiatric

0115: Hospice

0116: Detoxification

0117: Oncology

0118: Rehabilitation

0119: Other

012X

Room and Board Semiprivate (two beds)

0120: General

0121: Medical/Surgical/GYN

0122: OB

0123: Pediatric

0124: Psychiatric

0125: Hospice

0126: Detoxification

0127: Oncology

0128: Rehabilitation

0129: Other

013X

Room and Board (3 and 4 beds)

0130: General

0131: Medical/Surgical/GYN

0132: OB

0133: Pediatric

0134: Psychiatric

0135: Hospice

0136: Detoxification

0137: Oncology

0138: Rehabilitation

0139: Other

014X

Room and Board Deluxe Private

0140: General

0141: Medical/Surgical/GYN

0142: OB

0143: Pediatric

0144: Psychiatric

0145: Hospice

0146: Detoxification

0147: Oncology

0148: Rehabilitation

0149: Other

015X

Room and Board Ward

0150: General

0151: Medical/Surgical/GYN

0152: OB

0153: Pediatric

0154: Psychiatric

0155: Hospice

0156: Detoxification

0157: Oncology

0158: Rehabilitation

0159: Other

016X

Other Room and Board

0160: General

0164: Sterile

0167: Self-care

0169: Other

  • The above-mentioned list of revenue codes for medical billing convey the place of the procedure performed and to which department the patient was administered and provided with required services.
  • Codes are numerous, and each code specifies the need for certain procedures along with the specialties.

The revenue codes for medical billing is quite extensive, and it’s also important to demonstrate how many codes are available. The list will be continued in the next article, so stay tuned!

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