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Revenue Codes, Descriptions, and Charges

All medical services provided to patients, whether inpatients or outpatients, have costs associated with them. This chapter covers form locators 42-49, lines 1-23, which are used for recording and totaling the cost of each service received for the billing period reflected on the claim (see Figure 12.1). To help the payer understand what services were received by the patient, how much each service costs, and when each service was received, the billing provider must fill in FLs 42-49 carefully and precisely.

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According to the current revenue code system defined by the National Uniform Billing Committee (NUBC) for the UB-04 claim form, every service is assigned a revenue code and description. Each revenue code and corresponding description reflects an item, accommodation, or service that is billable by providers. Because revenue codes and descriptions provide the exact details of the service received, they play a key role in determining the final reimbursement amount.

The original NUBC revenue code system used three-digit codes numbered from 001 to 999. To accommodate the need for more codes, the coding system was expanded to a four-digit system. A leading zero was added to the original three-digit codes to make them four-digit codes.

Revenue codes are grouped into major categories, such as Room and Board—Private (011X), Pharmacy (025X), and Physical Therapy (042X). This chapter lists all revenue codes. Descriptions and usage guidelines are provided for the major revenue code categories. Billing tips help explain revenue codes that are often reported incorrectly. For quick reference, Appendix A contains a numerical list of all revenue codes as well as an alphabetical list of selected codes.

Describe the use of the two types of revenue codes that are reported in FL 42 (Revenue Code) on the UB-04: accommodation revenue codes and ancillary service revenue codes.

Become familiar with the narrative description or standard abbreviation that accompanies each revenue code for FL 43 (Revenue Description).

Understand the use of FL 44 (HCPCS/Rate/HIPPS Code) for reporting either the required HCPCS codes on outpatient claims or the charge for accommodations on inpatient claims.

Understand how to report the date of service in FL 45 (Service Date) and the units of measure in FL 46 (Service Units).

Understand how to report total charges and noncovered charges in FL 47 (Total Charges) and FL 48 (Noncovered Charges).

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