Mar 10, 2018 aha ed materials including the ub04 codes and descriptions may not be removed, copied, or utilized within any software revenue code. The provider enters a narrative description or standard abbreviation for each revenue code shown in fl 42 on the adjacent line in fl 43. Ub04 claim form e december 2018 3 ub04 claim form description the ub04 claim form is used to request reimbursement for services rendered by the following institutions. Locator 44, all revenue codes require a cpt hcpc procedure code when applicable based on the national uniform billing standards. The blended rate codes 5250 through 5259 are monthly rates representing an aggregate minimum number of facetoface encounters with patients within a calendar month. For a medicare skilled level of care revenue code 0022, therapy is included in the rug. Whats the difference between cms1500 and ub04 or cms1450. Health monitoring 5, 520, 900, 914 smoking cessation treatment 310 min 5, 520, 900, 914 smoking cessation treatment 10 mins 5, 520, 900, 914 medication therapy management 5, 520, 900, 914 alcohol and.
An x in the matrix below indicates acceptable coding. In short, revenue codes are descriptions and dollar amounts charged for hospital services provided to a patient. Medicare ub04 revenue codes revised august 2010 national government services, inc. A charge master is a listing of every single procedure that a hospital can provide to its patients. Hospitals have charge masters because it helps to make the process of charge capture and billing move smoother. Hospitalization hospitalization is the highest level. To limit the number of line items on each bill, it should sum revenue codes at the zero level to the extent possible. The hospice uses the following revenue codes to bill medicare.
Specific revenue codes should be selected if at all possible i. Sep, 2017 general information is also provided about the use of national ub04 revenue codes. It contains all the descriptions, revenue codes, department. Aha ed materials including the ub04 codes and descriptions may not be removed, copied. It must enter the appropriate numeric revenue code on the adjacent line in fl 42 to explain each charge in fl 47.
Enter the 2digit alphanumeric code and date if applicable. Ub04 billing instructions for long term care claims. To license the electronic data file of ub04 data specifications, contact tim carlson at 312 8936816 or laryssa. Want to receive articles like this one in your inbox. May 03, 2015 up to 22 revenue codes and associated charges may be entered on each ub04 the type of bill codes and ub04 claim frequency type code values for refer to the service code descriptions in subchapter 6 of the home. If an entity wishes to utilize any aha materials, please contact the aha at 3128936816. Revenue codes 300319 and 490 for outpatient require a cpthcpcs procedure code in form locator 44. Part b services with applicable revenue codes include. Although the instructions that follow are based on the ub04 paper claim form, they are also intended as a guideline for electronic billers to find out what information they need to provide in their claims. This includes items such as cpt codes, cdt codes, icd10 and other ub04 codes. For further electronic claim submission information, refer to the emedny 5010 companion guide which is available at.
The minimum number of facetoface encounters is based on the configuration of the blended team. Revenue code list with description medicare payment. Medicare claims processing manual crosswalk centers for this form, also known as the ub04, is a uniform institutional provider bill suitable the provider enters the appropriate revenue codes from the following list to. In the moderate sedation codes section of the cpt manual 9914399150, the preface states that the code includes the administration of the agents. Icd9cm, hcpcs, cpt, icd9cm procedure codes, revenue codes. Jan 1, 2016 classification apc, hcpcs modifier, and revenue code additions, the key changes to and billing instructions for various payment policies. Because it serves many payers, a particular payer may not need some data elements. Oct 29, 2007 1 select ub04 claim submission from the top menu or click on the new ub04 claim the following fields will need to be completed under the service use. Claims and billing manual page 5 of 18 recommended fields for the cms1450 ub04 form institutional claims continued field box title description 10 birth date members date of birth in mmddyy format 11 sex members gender. The national uniform billing committee nubc maintains lists of approved. Claims and billing manual page 4 of 18 3b the following 1 2 recommended fields for the cms1450 ub04 form institutional claims field box title description 1 r untitled provider name, address and telephone number name, address and phone number of the billing facility or service supplier 2 untitled paytoname, address.
Please read the instructions carefully for entering the new number of days information in the value code fields. Hcpcs codes begin with a single letter a through v followed by four numbers. Up to 22 revenue codes and associated charges may be entered on each ub04 the type of bill codes and ub04 claim frequency type code values for refer to the service code descriptions in subchapter 6 of the home. The following chart reflects hcpcs coding to be reported under opps by hospital. Aarp health insurance plans pdf download medicare replacement pdf download aarp. For inpatient services, the revenue code identifies the department in which the service was given, the types of services provided, and the supplies used. Revenue preferred drug list pdl facility and program services revenue codes. Learn vocabulary, terms, and more with flashcards, games, and other study tools. No other publication governmental or privatecommercial can be considered authoritative. Skilled nursing facility quick reference billing manual. For information on the ub04 billing form, or to obtain an official ub04 data specifications manual.
Report anesthesia charge using revenue code 370 and no hcpcs apcs insider, april 20, 2007. When a cpt and a hcpcs code have very similar descriptions for a procedure or service, use the cpt code. Revenue code icd10 cm code date of birth type of bill code 0762 observation room x hospital outpatient applicable cpt codes for contracts exclusive of professional services 1. Become an organ donor enroll today drinking water response activities. You can access the ub04 billing information adopted by the nubc by subscribing to the official ub04 data specifications manual. For complete information regarding ub04 coding please refer to the cms iom publication 4, chapter 25 2. Inpatient hospital facilities, such as medicalsurgical intensive care, burn care, coronary care and ancillary charges such as labor and delivery, anesthesiology and.
Understanding hospital revenue codes value healthcare services. This manual, ed by the american hospital association, is the only official source of ub data. Enter the code from the list of occurrence codes listed in the code sets for the ub04 do not include revenue codes for roomandboard charges incurred on. Ub04 claim form instructions form locator name instructions 1. We will return claims submitted on the ub92 form, blackandwhite copies of the ub04 form, turnaround document tad or extended care invoice dhs 1039 with a. The list of hcpcs codes indicating the apcs to which each is. Prior to april 1, 2016, one providers are 1 unit equaled one 1 visit. Other code categories are locally defined and individually described on each bill. Revenue code description effective from effective through inpatien t.
Revenue code description effective from effective through inpatien t outpatient fqhcrhc dialysis hhpdn rtc hospice nf comments 0010. Understanding hospital revenue codes value healthcare. Revenue code 001 must be entered in form locator 42 line 23 with corresponding total charges entered in form locator 47 line 23. It should be used as a vehicle to supply program information as defined in the providerpayer contract. Ub04 billing instructions for hospital providers louisiana medicaid. In the amount box, enter the number, amount, or ucr value associated with that code. Ub04 data field requirements independence blue cross. Chapter 25 completing and processing the form cms1450 data set. Hcpcs is an acronym for healthcare common procedure coding system hcpcs. Tips for completing the ub04 cms 1450 claim form page 4 of 17 field field description field type instructions 42 revenue code required use this field to report the. Room and board private one bed 0111 medicalsurgicalgyn. In form locator 15 on the ub40 claim form, the codes for physician referral, hmo referral, and transfer from a skilled nursing facility snf represent. December 10, 2019 policies and procedures as of july 1, 2019 version. On the paper ub04 report the total for all revenue codes as indicated.
Accommodation codes require a rate in form locator 44. Revenue codes 042x physical therapy, 043x occupational therapy and 044x speech therapy. Replacementcorrected claims require a type of bill with a frequency code 7 field 4 and claim number in the. Jun 1, 1997 cms1450 ub04 form locators and field descriptions b. Revenue code required enter the appropriate 4 digit revenue codes that describe the services provided. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download. Appropriate procedure codes are available to it from its fi. Revenue code description effective from effective through outpatient rtc. You can use this revenue code as often as necessary to indicate different rate. Ub04 form the uniform bill ub04 is the standardized billing form for institutional services. Hospitalization hospitalization is the highest level of skilled psychiatric or substance abuse services provided in a facility. Jun 24, 2015 jun 1, 1997 cms1450 ub04 form locators and field descriptions b. For npi requirement changes, april 1, 2012 implementation date. Blue cross and blue shield of new mexico offers this guide for completion of the ub04 form for your patients with blue cross facility coverage.
Inpatient revenue codes for feeforservice providers. Ub04cms1450 revenue codes group 01 ub04 revenue codes. May 26, 2016 billing is limited to the 51x clinic revenue codes series. Enter the applicable revenue codes which identifies the service provided. Thats where revenue codes come into play to help make the whole process smoother and universal. Reporting revenue code on ub 04 asc billing code and. Pay to address pay to address if different than field 1. The blended rate codes 5250 through 5259 are monthly rates representing an aggregate minimum number of. I am not a us based user, but i tried to understand the system for european coding with icpccodes. Outpatient partial hospitalization program using revenue code 0910 shall now report. Revenue code listing below revenue codes must be filed with appropriate cpt and hcpcs codes for outpatient and ambulatory surgery ub04 or 837institutional healthcare claims. Ub04 revenue codes are used for revenue coding on the ub04 or cms1450 form. You can access the ub04 billing information adopted by the nubc by.
Updated guidance on nursery revenue codes 017x effective july 1, 2020. Tips for completing the ub04 cms 1450 claim form failure to provide valid information matching the insureds id card could result in a rejection of your claim. Below revenue codes must be filed with appropriate cpt and hcpcs codes for outpatient and ambulatory surgery ub04 or 837institutional healthcare claims. Procedure codes are required in order for the fi to make reasonable charge determinations when paying the hospice for physician services. To determine the number of units, follow the guidelines below. Post eligibility treatment of income peti nursing facility. Revenue code enter a four digit revenue code beside each service described in column 43. All revenue codes should be extended to four digits. Health insurance prospective payment system hipps 00200021 reserved. Desk reference for inpatient revenue codes for feeforservice 837 institutionalub92 claim form. I am just getting into medical billing and coding, this is a life saver.
Section references are to the internal revenue code unless otherwise noted. Ub04 revenue codes icd 10 codes, cpt codes, hcpcs codes. Hospice billing manual colorado department of health care policy. Hcpcs code a0422 ambulance als or bls oxygen and oxygen supplies now has an federal medical assistance percentage for ffys 2018 and 2019, facilities and institutional providers billing on a ub04 claim form 2019 instructions for form 1099misc irs. Revenue codes 89x other donor bank are now unassigned.
Official guidelines for billing all asc providers shall complete the form dfsf5dwc90 ub04 according to the form locator attributes and notes. Aarp health insurance plans pdf download medicare replacement pdf download. Refer to the colorado medical assistance program ub04 revenue code. If you have questions regarding proper matching of cpt codes to revenue codes, or the relevant billing units, information is provided in the ub04 editor, available from st.
Additionally, system changes are needed in order to comply npi requirements for ambulance services. Descriptions or abbreviations correspond to the revenue codes. Aha ed materials including the ub04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the aha. Of you speak about revenue like money to receive, it would be equivalent to cpt4. Report anesthesia charge using revenue code 370 and no. Newborn coding structure must be used when the priority type of visit code in. Introduction to ihcp claim submission and processing 2 library reference number. The ub04 uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims. Medicare claims processing manual centers for medicare. The codes are grouped by the type of service or supply they represent. The type of bill codes and ub04 claim frequency type code values for. Valid claim formats dmap only accepts commerciallyavailable red form versions of the ub04 claim form.
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