Revenue Code In Ub04

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 4 irf pps cmg.

Revenue code in ub04. 42 revenue code required the provider enters the appropriate revenue codes to identify specific accommodation and or ancillary charges. 0138 rehabilitation ub04 revenue code. Revenue code description effective from effective through inpatien t outpatient fqhc rhc dialysis hh pdn rtc hospice nf comments 0010. 0134 psychiatric ub04 revenue code.

Page 2 of 99 fl 37 not used 38 fl 38 responsible party name 38and address fl 39 41 value codes and amounts 38 fl 45 s ervic dat 46. 0135 hospice ub04 revenue code. 0136 detoxification ub04 revenue code. 0139 other ub04 revenue code.

Ub 04 revenue code table. It must enter the appropriate numeric revenue code on the adjacent line in fl 42 to explain each charge in fl 47. If a patient is in observation for more than 24 hours hospitals should bill the first 24. 0137 oncology ub04 revenue code.

013x semi private three and four beds medical or general ub04 revenue code. Additionally there is no fixed total line in the charge area. 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. Ub04 hospital addendum instructions.

Observation stays on a ub04 using bill type 131 in form locator fl 4 and revenue code 0762 in fl 42. Ancillary exceeding 28 lines.