Revenue Code On Ub04

It must enter the appropriate numeric revenue code on the adjacent line in fl 42 to explain each charge in fl 47.

Revenue code on ub04. 42 revenue code required the provider enters the appropriate revenue codes to identify specific accommodation and or ancillary charges. Revenue code description effective from effective through inpatien t outpatient fqhc rhc dialysis hh pdn rtc hospice nf comments 0010. Ancillary exceeding 28 lines. Because it serves many payers a particular payer may not need some data elements.

Basic billing concept ub 04 ub 04 field 39 42. Ub 04 revenue code requirements for behavioral health services in compliance with anthem behavioral health policy the following revenue codes must be used when submitting claims for behavioral health services billed on ub 04 claim forms for members of anthem blue cross and blue shield s behavioral health plans. 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. Additionally there is no fixed total line in the charge area.

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. For bill type 21x 32x 33x or 11x irf facilities the following revenue codes require a 5 position hipps code. Medicare ub 04 revenue codes revised august 2010 national government services inc.