Example 1 —Clean claim The inpatient revenue code claim line best practice billing is to complete a single claim line In other words, the area which bears the costs for the services. Child Care only 16 – AWOL will be revenue code 0189 in FL 42. R 43* Revenue Description Enter … Learn More The Uniform Billing Editor provides detailed, accurate, and timely information about Medicare and UB-04 billing rules and assists the user with 5010 data, UB-04 and 837i requirements. 50: Assessment Date for IRF, SNF and SB PPS Note: Not required for SNF HIPPS code AAAxx: 51: Date of last Kt/V reading: 55: Date of Death: A1: Birth Date Insured A - birth date of insured in whose name the insurance is carried. 14 - Therapeutic Leave will be revenue code 0183 in FL 42. 10/15/2003 : 0011 . To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. Although some make more sense than others, possible revenue codes might include: 0456 Urgent Care; 0516 Urgent Care Clinic; 0519 Other Clinic Cpt and Revenue codes are realted in determining the coverage, Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. UB04 Hospital . UB-04 Products Subscribe License FAQs Resources Calendar Contact Us NUBC Resources. Updated Guidance on Other Implant Revenue Code (0278) NUBC Announcement for COVID-19 Claims . The first 24 hours spent in an observation bed should be billed under Revenue Code 0762 in FL 46 (Service Units) and FL 47 (Total Charges). There are a total of six possible hospital revenue codes noted in the Uniform Billing Editor (UB-04), which can be used to submit claims for inpatient. ... Access the Official UB-04 Data File containing the complete set of codes… The two revenue codes listed above (0361, 0510) are valid options, as is revenue code 0761. Revenue codes and procedure code combinations that are submitted on outpatient claims should reflect the services that were provided to the patient on that date of service. The Outpatient Code Editor will be changed to no longer accept revenue code 0910 for the October release. 10/1/2002 . After the last Revenue Code, enter "0001" corresponding with the Total Charges amount in column 47. A revenue code and corresponding HCPCS or CPT code must be compatible. the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. UB-04 claims submission uide 1 The UB-04 claim form, also known as the CMS-1450 form, is approved by the Centers for Medicare & Medicaid ... 47 Total Charges (by Revenue Code) Required Required. Abstract: The Official UB-04 Data Specifications Manual 2021, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing Committee (NUBC).No other publication—governmental or private/commercial—can be considered authoritative. Introducer sheaths are typically used only during the procedure and then removed and would not be considered an implant. Revenue Code Description Effective From Effective Through Inpatien t Outpatient FQHC/RHC Dialysis HH/PDN RTC Hospice NF Comments 0010 . Each digit has a specific purpose and is required on all UB … What are UB04 Revenue Codes? CAPITAL AND COSTS . For additional information regarding loops and segments, please access the 5010 Companion Guides ( JL ) … 5 days ago … The January 2019 Integrated Outpatient Code. UB-04 Revenue Code Table . “The revenue codes for “Other” (ending with 0XX9) are assigned at the state level for local billing needs. Type of bill codes are three-­digit codes located on the UB-04 claim form that describe the type of bill a provider is submitting to a payer, such as Medicaid or an insurance company. The Outpatient Code Editor will be changed to no longer accept revenue code 0910 for the October release. Page 13/24. 472 0 obj <> endobj There are a total of six possible hospital revenue codes noted in the Uniform Billing Editor (UB … Enter a revenue code for each service. h�bbd``b`�$[@D"�`;$8A�� �]�"�@�V ��$��A�V �$ځĒ�L��� .#���� � $ The two revenue codes listed above (0361, 0510) are valid options, as is revenue code 0761. You might find that the payor is expecting a different revenue code. The Uniform Billing Editor provides detailed, accurate, and timely information about Medicare and UB-04 billing rules and assists the user with 5010 data, UB-04 and 837i requirements. What are UB04 Revenue Codes? Medical Assistance Problem Resolution. Editor's note: Randy Wiitala, director of revenue integrity for Navigant, answered this question. Please be clotting factors, epoetin alfa, and darbepoetin alfa must be billed with revenue codes 0634, 0635 or 0636 and detailed CPT or HCPCS coding. Professional services are rarely billed on UB-04 form (and most payers would not even accept them billed this way), but if they are included on the UB-04 they would have to be billed using revenue codes 960-989. Outpatient facility and hospital claims may be denied when received without the corresponding codes associated with the following revenue codes. No other publication — governmental or private/commercial — can be considered authoritative. The UB-04 is a uniform institutional bill suitable for use in billing multiple third party liability (TPL) payers. Welcome to the Newly Redesigned Website of the National Uniform Billing Committee, Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. Inpatient Admissions – Washington State Health Care Authority. For a list of condition codes, occurrence codes, occurrence span codes, value codes, revenue codes and all other required data reported on the UB-04, please visit the NUBC website for the official UB-04 data specifications manual or the UB-04 Form Locator Code Lookup on our website. 42. National payers such as Medicare will accept these codes as if they were billed under the general revenue code (ending with 0XX0). ….. change from the UB-92 form for hospital claims billing to the UB-04 form …. Revenue Code Description; 0001: Total Charges: 001X: Reserved for internal payer use: 002X: Health Insurance Prospective Payment System (HIPPS) 0020-0021 Reserved A new release of the UB-04 manual will occur each year along with a change log indicating the changes made during the course of the year. Medicare Revenue Code List Medicare UB-04 Revenue Codes Revised August 2010 National Government Services, Inc. For complete information regarding UB-04 coding please refer to the CMS IOM Publication 100-04, Chapter 25 1 294_0810 0001 Total Charge 002X HI Prosp Paymt System – HIPPS 2 SNF PPS (RUG) 3 HH PPS (HRG)... Medicare UB-04 Revenue Codes You can access the UB-04 billing information adopted by the NUBC by subscribing to the Official UB-04 Data Specifications Manual. Get answers to your questions about the UB-04 manual including content, ordering, delivery, installation, printing and access. Revised 2/12 . Medicare UB-04 Revenue Codes Revised August 2010 National Government Services, Inc. For complete information regarding UB-04 coding please refer to the CMS IOM Publication 100-04, Chapter 25 1 294_0810 0001 Total Charge 002X HI Prosp Paymt System – … Type of Bill Frequency Code Excerpts for 837p and 837d. 488 0 obj <>/Filter/FlateDecode/ID[<9FC99B388D6D3544B3D029B8B4685497>]/Index[472 28]/Info 471 0 R/Length 83/Prev 45126/Root 473 0 R/Size 500/Type/XRef/W[1 2 1]>>stream If the claim Stacy A. Hromanik, Division Chief, MAPR . Each digit has a specific purpose and is required on all UB-04 claims in field locator 4. The Uniform Billing Dataset was developed and approved for general hospital use by the National Uniform Billing Committee (NUBC). Bill outpatient ancillary services received during an observation stay using appropriate revenue codes and HCPCS codes on the same UB-04 form as the observation services. Access the Official UB-04 Data File containing the complete set of codes. Refer to the most current Uniform Billing Editor for appropriate code sets. 0 Features and benefits include: ... Quickly link HCPCS and CPT® codes to applicable revenue codes. The Outpatient Code Editor will be changed to no longer accept revenue code 0910 for the October release. You can access the UB-04 billing information adopted by the NUBC by subscribing to the Official UB-04 Data Specifications Manual. endstream endobj startxref INSTRUCTIONS FOR COMPLETING THE UB-92 CLAIM FORM If one of the codes below is used, a Status Code from the table above must still be entered in FL22. The revenue code must be four digits. When submitting the above claims, complete all items required by each payer who is to receive a copy of the form. Outpatient Claims: This is a mandatory field and must be populated. Example 1 —Clean claim The inpatient revenue code claim line best practice billing is to complete a single claim line COVERED REVENUE CODES – INPATIENT SERVICES. The 'Integrated' Outpatient Code Editor (I/OCE) The 'integrated' Outpatient Code Editor (I/OCE) program processes claims for all outpatient institutional providers including hospitals that are subject to the Outpatient Prospective Payment System (OPPS) as well as hospitals that are NOT (Non-OPPS). The IHCP will continue to manually link procedure codes to the revenue codes … All rights reserved. UB-04 Billing Instructions for Hospice Claims 6 Locator # Description Instructions Alerts (CSBA) Codes that Medicare has implemented. h��W]Oc7�+~l����Z ��"���u+!n���%wU��w��:� �P^Z��`�3��3�>e���Z�̃Q>�`U�<8e���+��GR��UrP&�$*��'�L�9=>>jW�5"��钗��݃��Oʲ��p�e�͛��t�~og��9:k�/�w��9>T�{�|�8H>|. CoreMMIS includes an integrated uniform billing (UB) editor to automatically link procedure codes to the appropriate revenue codes. HCPCS codes are required in FL 44 HCPCS/Rates, for billing other imaging services under RC 040X with TOB code (FL 4) 013X or 083X. Please use the appropriate MSA codes. are “Codes that identify specific accommodation, ancillary service or unique billing calculations or arrangements”. No other publication — governmental or private/commercial — can be considered authoritative. 3, sec. Payer Codes - for use by third party payers only. 18 Service encounter reporting instructions guidance for revenue code and HCPC pairing . Field 42 on Form CMS-1450 (or UB-04) by using revenue code 0819. ANCILLARY EXCEEDING 28 LINES . Billin codes) • Hospice (room and board only) • Organ procurement For Section 340B providers submitting claims for physician administered drugs: omitting the modifier UD. What are UB04 Revenue Codes? The following chart provides a crosswalk for each block of the 1450 (UB-04) paper claim form and the equivalent electronic data in the ANSI ASC X12N format, version 5010. ACA - Operating Rules and CORE. Description Enter a brief description that corresponds to the Revenue Code in column 42. changes to HCPCS codes and Medicare Physician Fee Schedule … January 2019 Update of the Hospital Outpatient Prospective … – CMS. data due March 1, 2016 – the newly added revenue codes will become part of the … SECTION 3 REVENUE CODES – INPATIENT. Because it serves many payers, a particular payer may not need some data elements. - Billed with HCPCS Q3014, No Modifier, UB04 Revenue Code 780 Community Mental Health Center - TOB 76X - Billed with HCPCS Q3014, No Modifier, UB04 Revenue Code 780 : Patient's Home No Facility Fee is Available The requirements in Table 2 and 3 are specific to … Receive updates on the latest deliberations and manual instructions. BlueCross uses the OPTUM Uniform Billing (UB) Editor for reference on revenue code assignments, unless otherwise noted in … The claim is audited for correctness before it is sent for payment. (Medicare Claims Processing Manual, Pub. Editor e-book for definition of and requirements for each Field Locator. However, use of revenue codes ending in “0” or “9” when a more The outpatient code editor determines if any services should not be billed. CAPITAL AND COSTS . This manual, copyrighted by the American Hospital Association, is the only official source of UB Data. Editor (I/OCE) …. Providers do not report these codes. Form Locator 4 - Type of Bill Frequency Code Excerpts for 837p and 837d. Dec 1, 2018 … UMP Plus–Puget Sound High Value Network … claims must include the appropriate room and board revenue codes. 10/1/2002 . The Uniform Billing Editor provides detailed, accurate, and timely information about Medicare and UB-04 billing rules and assists the user with 5010 data, UB-04 and 837i requirements. Code Description. A revenue code and corresponding HCPCS or CPT® code must be compatible. h�b```�\�(>�c`��0p8x��a��� .�:��vޥ��K�J���e���y��aX����i�fe`q�k�b`����h5@� �#� These codes should be submitted on the same line for accurate claims processing. Form CMS-1450 (UB-04) This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers. Describe why existing UB-04 codes or alternative approaches are insufficient. ANCILLARY EXCEEDING 28 LINES . The CMS assigns for FI use. Key Features and Benefits • Quickly locate topics based on field locators, revenue codes, or coding structures. Category Type of Bill PTAN Range(s) Ancillary: 12X, 22X, 42X, 52X: Same as 11X, 5000-6499: Community Mental Health Center (CMHC) 76X: 1400-1499, 4600-4799, 4900-4999 Harvard Pilgrim Health Care—Provider Manual H.31 January 2021 Payment Policies Billing Requirements for Outpatient Revenue Codes Outpatient Revenue Codes1 outpatient UB-04 claims must be billed with both a revenue code and a cPt or HcPcs code.2 a revenue code must be assigned (Form locator [Fl] 42) on the paper UB-04 or loop 2400, sV2 segment with appropriate revenue code … c. Only Medicare claims are reviewed prior to being sent to the payer. € New UB-04 codes will be implemented according to an annual update cycle each July 1. As many hospitals know, commercial and managed care insurances often have problems correctly processing claims with revenue code 0510; therefore, revenue code 0361 or 0761 are valid options. endstream endobj 473 0 obj <>/Metadata 8 0 R/PageLayout/OneColumn/Pages 470 0 R/StructTreeRoot 12 0 R/Type/Catalog>> endobj 474 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 475 0 obj <>stream Outpatient facility and hospital claims may be denied when received without the corresponding appropriate HCPCS/CPT codes associated with the following list of revenue codes. This manual, copyrighted by the American Hospital Association, is the only official source of UB Data. The total ….. As directed in the UB-04 Editor… 05/2017 2 Field location UB-04 Description Inpatient Outpatient intensive care nursery, using industry standard hospital revenue codes. CMS-1450 UB-04 substance use disorder revenue codes with required HCPC code . ... (CMS-1500 or UB-04) CMS-1500: In the shaded portion of line-item field 24A-24G, enter NDC qualifier N4 (left- (Example: rev code 450 – emergency department) UB only. To request permission to reproduce AHA content, please, Official UB-04 Data Specifications Manual, UB-04 Change Implementation Calendar Updated, NUBC Change Implementation Calendar as of 10-21-20, NUBC announces new condition codes effective February 1, 2021, NUBC Change Implementation Calendar 06-17-20, NUBC announces new Point of Origin Code for Designated Disaster Alternate Care Sites effective July 1, 2020, Point of Origin Code for Designated Disaster Alternate Care Sites, Appropriate Use Criteria – Reporting NPI and G1011 Information on Paper Claims, Appropriate Use Criteria – Reporting NPI and G1011, Updated Guidance on Other Implant Revenue Code (0278) effective July 1, 2020, Updated Guidance on Other Implant Revenue Code (0278), NUBC Member-Only Conference Call Schedule, Summary of Gene and Cell Therapy Code Changes, Meeting Details for April 2020 NUBC Meeting Posted, August 2019 NUBC Meeting Tentative Agenda as of 8-6-19, National Uniform Billing Committee (NUBC)/UB-04. A revenue code and corresponding HCPCS or CPT® code must be compatible. surgical procedure codes on October 1, 2015. A2 Billing Tip: Check instructions in the UB-04 Completion: Outpatient Services section of this manual for the appropriate location of modifier UD for Section 340B drugs on the UB-04. In addition, the UB-04 manual specifies the patient’s reason for visit is required for all unscheduled outpatient visits. observation stays on a UB04 using Bill Type 131 in Form Locator (FL) 4 and Revenue Code 0762 in FL 42. Form CMS-1450 (UB-04) This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers. Understand billing structures such as Type of Bill Codes and Revenue Codes, and access proprietary UB-04 billing and coding tips that address problems that are core to hospital revenue cycle processes. UB-04 Revenue Code Table . The revenue codes listed in Table 1 are exceptions to this automatic linkage. Revenue codes must be listed vertically in ascending order. HCPCS/Rate/HIPPS Codes (form locator 44): Enter a HCPCS code applicable for the ancillary service for outpatient claims, a HIPPS rate code, or the inpatient accommodation rate. Revenue Code conflict Effective Feb. 1, 2020, facility claims with a mismatched procedure and revenue codes as determined by the Uniform Billing Editor, will be denied. € All newly approved codes, including emergency (off-cycle) changes, together Type of bill codes are three-­digit codes located on the UB-04 claim form that describe the type of bill a provider is submitting to a payer, such as Medicaid or an insurance company. Because it serves many payers, a particular payer may not need some data elements. The information, tools, and resources you need to support the day-to-day needs of your office 100-04, chap. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. Revenue code 0250—pharmacy is not appropriate for billing these categories of drugs. The total ….. As directed in the UB-04 Editor, bill ….. Our goal is to achieve administrative simplification as outlined in the Heath Insurance Portability and Accountability Act of 1996. When a UB-04 claim is reviewed retrospectively, this means: a. (See Section 800, "Revenue Codes.") For more clarification regarding how and when to use these codes, refer back to the National Uniform Billing Editor. We actively engage the health care community in the discussion of the issues. b. FL42 Revenue Codes FL43 Revenue Code Description/IDE Number/Medicaid Drug rebate FL44 HCPCS/Accommodation Rates/HIPPS Rate Codes FL45 Service Dates FL46 Service Units FL47 Total Charges FL48 Non-Covered Charges FL49 Unlabeled ... UB … Form CMS-1450 (UB-04) This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers. Sample UB-04 forms for inpatient and outpatient claims can be found on pages 4 and 5. If a patient is in observation for more than 24 hours, hospitals should bill the first 24 Download Free Medicare Revenue Code List CMS Manual System Page 2 of 3 Reimbursement Policy:R29. The Uniform Billing Editor provides detailed, accurate, and timely information about Medicare and UB-04 billing rules and assists the user with 5010 data, UB-04 and 837i requirements. 13 - Hospital Leave will be revenue code 0185 in FL 42. 10/15/2003 : 0011 . For a list of condition codes, occurrence codes, occurrence span codes, value codes, revenue codes and all other required data reported on the UB-04, please visit the NUBC website for the official UB-04 data specifications manual or the UB-04 Form Locator Code Lookup on our website. Billing Codes 2019 Revenue Codes: Codes from the Uniform Billing Editor are used to indicate the various services provided during a hospitalization. A HCPCS code is required when a drug or biological is reported. 42* Revenue Code Enter the appropriate numeric code to identify specific accommodations and/or ancillary service in ascending numeric order, by date of service if applicable. Revenue Code Description Effective From Effective Through Inpatien t Outpatient FQHC/RHC Dialysis HH/PDN RTC Hospice NF Comments 0010 . Revenue Code Enter a four digit Revenue Code beside each service described in column 43. Features and benefits include: ... Quickly link HCPCS and CPT® codes to applicable revenue codes. Professional services are rarely billed on UB-04 form (and most payers would not even accept them billed this way), but if they are included on the UB-04 they would have to be billed using revenue codes 960-989. © 2021 by the American Hospital Association. Instructions for completion are the same for inpatient and outpatient claims unless otherwise noted. Dec 1, 2018 … UMP Plus–Puget Sound High Value Network … claims must include the appropriate room and board revenue codes. In general, the revenue code ties the charges to a specific cost center(s) in a facility. 499 0 obj <>stream Institutional Hotline: 410-767-5457 . Many payors will reimburse hospitals (even for off-site urgent care centers) for the facility fee on the UB-04. If there is more than one (1) occurrence of Revenue Codes (form locator 42): Revenue codes represent a specific accommodation and/or ancillary service. Refer to the most current Uniform Billing Editor for appropriate code sets. services to neonates, both normal full term infants, and sick/premature neonates in the NICU. *Asterisked codes are exempt from the outpatient cap. Apr 8, 2020. SECTION 3. the current Uniform Billing Editor for appropriate code sets. The best practice recommendation is to assign UB-04 revenue code 272 (sterile supply) to these devices. Revenue code 0900 remains a valid code under the general classification subcategory in the “Behavioral Health Treatments/Services” category and will be used in place of revenue code 0910 for Medicare claims processing purposes. %PDF-1.5 %���� This code is required on line 4 of the UB-04. If you have any questions regarding the UB-04 claim form, please call your Network Coordinator or Customer Service at 1-800-ASK-BLUE. REVENUE CODES – INPATIENT. (PAPER CLAIMS ONLY) 43. 18 Service encounter reporting instructions guidance for revenue code and HCPC pairing . Inpatient Admissions – Washington State Health Care Authority. Updated Guidance on Other Implant Revenue Code (0278) effective July 1, 2020. Outpatient facility and hospital claims may be denied when received without the corresponding appropriate HCPCS/CPT codes associated with the following list of revenue codes. The following changes apply to UB-04 Hospital billing for Inpatient Admissions and Outpatient Services: For Inpatient admissions ICD-10 CM diagnosis and surgical procedure codes will be required for discharges on or after October 1, 2015. Medicare UB-04 Revenue Codes Revised August 2010 National Government Services, Inc. For complete information regarding UB-04 coding please refer to the CMS IOM Publication 100-04, Chapter 25 1 294_0810 0001 Total Charge 002X HI Prosp Paymt System – HIPPS 2 … This billing requirement is consistent with UB04 editor guidelines. If you have questions regarding proper matching of CPT codes to revenue codes, or the relevant billing units, information is provided in “The UB-04 Editor®”, available from St. Anthony Publishing at 800-632-0123. Field 42 on Form CMS-1450 (or UB-04) by using revenue code 0819. Pathology services must be billed with the appropriate Pathology CPT code and the Revenue Code 031X. UB-04 Change Implementation Calendar . %%EOF Key features and benefits of this ebook: Quickly locate topics based on field locators, revenue codes, or coding structures. As many hospitals know, commercial and managed care insurances often have problems correctly processing claims with revenue code 0510; therefore, revenue code 0361 or 0761 are valid options. UB-04 data field requirements Field location UB-04 Description Inpatient Outpatient 1 Provider Name and Address Required Required 42 Revenue Code Required. 2011) HCPCS codes 70010–79999 are valid when reported with this revenue code for all Medicare outpatient claims. Refer to the most current Uniform Billing Editor for appropriate code sets. An accommodation rate is required when a room and board revenue code is billed (revenue codes 0100s through 0219) Service Date (form locator 45): The dates for when the service indicated was provided. ACCOMMODATIONS. Category Description Engage in the development of operating rules for the HIPAA transaction by becoming members of CORE. Includes information on the background of the NUBC, administration of NUBC meetings, methodology for request for changes and more. July 2011. 11 Examples POS CMS-1450 UB-04 substance use disorder revenue codes with required HCPC code . Revenue code 0001 must be the final entry on all bills. A. This code is required on line 4 of the UB-04. All Revenue codes should be extended to four digits. An unscheduled outpatient visit is defined as an outpatient type of bill 013X or 085X, together with FL14 codes 1, 2, or 5 and revenue codes 045X, 0516, 0526 or 0762 (observation room).
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