What Is the Revenue Code in Medical Billing and How Do They Assist Health Practitioners?

The revenue code in medical billing identifies the number of treatments that a patient opted for, where he was at the time of treatment, and what resources he might have received during treatments. Revenue codes are essential to be accurate in the medical claims to prevent the medical claims from rejection.

Revenue codes also inform the insurance companies whether the covered patient was treated in the emergency room, in the operation theater, or in any other specific department.

These revenue codes are of three types and forms that are widely accepted and used across the country. They include ICD-10 (identifies the characteristic of the disease), CPT (refers to the treatment rendered), and HCPCS (shows the resources used during the treatment).

There are also some modifiers and supply codes attached to these codes to modify their meaning accredited by the insurance companies. When a supply code is added with the revenue codes, it evaluates the use of resources/equipment and identifies if the patient used the equipment at the facility or was taken home.

This is an important thing to mention as there is equipment that is used in the hospitals but is needed at home to continue the treatment such as oxygen cylinders. Plus, the cost of the service drastically changes when the place of the service changes.

For instance, if a patient needs stitches, they can be given to an emergency room after an accident and can be given to a patient in the maternity room. The scenarios also affect the type of treatment and place of the procedure on the cost of services and of course, it needs appropriate revenue codes to reimburse accordingly.

Updated List of Revenue code in medical billing

Revenue Code on UB-04

UB-04 is the form of bills that hospitals and healthcare providers use for claims. Revenue codes can be easily spotted in the UB-04 form basically with the purpose to list down the similar types of charges separately in the form. It is also necessary to understand that the revenue codes can only be submitted through the UB-04 form, not in the CMS-1500 form. This is because in UB-04 forms you can charge for the resources and supplies that have been used during the treatment.

For this, billers need to refer to the valid supply code/procedure code with the revenue codes so they will be accepted by the insurance provider.  Revenue codes specifically were generated for the Medicare healthcare system but soon after they were accepted by hospitals and practices as standard revenue codes for claims and reimbursements.

List of revenue code 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

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
• 017X    Nursery
• 0170 – General
• 0171 – Newborn Level I
• 0172 – Newborn Level II
• 0173 – Newborn Level III
• 0174 – Newborn Level IV
• 0179 – Other

018X: Leave of Absence

• 0180 – General
• 0182 – Patience convenience – charges billable
•  0183 – Therapeutic leave
• 0185 – Nursing home (for hospitalization)
• 0189 – Other

019X: Subacute Care

• 0190 – General
• 0191 – Level I
• 0192 – Level II
• 0193 – Level III
• 0194 – Level IV
• 0199 – Other

020X: Intensive Care Unit

• 0200 – General
• 0201 – Surgical
• 0202 – Medical
• 0203 – Pediatric
• 0204 – Psychiatric
• 0206 – Intermediate ICU
• 0207 – Burn Care
• 0208 – Trauma
• 0209 – Other

021X: Coronary Care Unit

• 0210 – General
• 0211 – Myocardial Infarction
• 0212 – Pulmonary Care
• 0213 – Heart Transplant
• 0214 – Intermediate CCU 0219 – Other

022X: Special Charges

• 0220 – General
• 0221 – Admission Charge
• 0222 – Technical Support Charge
• 0223 – UR Service Charge
• 0224 – Late Discharge – Medically Necessary 0229 – Other

023X: Incremental Nursing Charge

• 0230 – General
• 0231 – Nursery
• 0232 – OB
• 0233 – ICU
• 0234 – CCU
• 0235 – Hospice
• 0239 – Other

024X: All-inclusive Ancillary

• 0240 – General
• 0241 – Basic
• 0242 – Comprehensive
• 0243 – Specialty
• 0249 – Other

025X: Pharmacy

• 0250 – General
• 0251 – Generic drugs
• 0252 – Non Generic drugs
• 0253 – Take-home drugs
• 0254 – Drugs incident to Other diagnostic services
• 0255 – Drugs incident to radiology
• 0256 – experimental drugs
• 0257 – Nonprescription
• 0258 – IV solutions
• 0259 – Other

These codes are up to 310x where 311X-999X are reserved.