Revenue Code Ub 04

Outpatient services section in this manual.

Revenue code ub 04. 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. Ub 04 tips for billing. The instructions included in this section are excerpts from medicare instructions rev. All codes are two alphanumeric digits.

Each code must be accompanied by an amount. Ub 04 revenue code table. Outpatient services page updated. 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.

Enter the total charge related to the revenue code subcategory listed in field 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. Ancillary exceeding 28 lines. August 2020 this section describes ub 04 claim fields that must be completed accurately and completely in order to avoid claim suspense or denial.

How to bill value and revenue codes in ub 04 a. 3709 02 03 17 along with commentary by. Revenue code description cpt hcpcs code 0300 0309 laboratory clinical diagnostic code for lab procedure performed 0310 0319 laboratory pathology code for pathology procedure performed. Tips below are designed to supplement instructions in the ub 04 completion.

What are ub04 revenue codes. Amounts may be up to ten numeric positions. Because it serves many payers a particular payer may not need some data elements. Specific codes required refer to ub 04 manual 54 prior payments enter the amount in dollars and cents received toward payment.

The following chart identifies revenue codes that require a specific cpt hcpcs code in field 44 of the ub 04. Medicare ub 04 revenue codes revised august 2010 national government services inc. This document explains the ub 04 claim form which is used for submitting claims for reimbursement for specially designated facilities. Revenue code description effective from effective through inpatien t outpatient fqhc rhc dialysis hh pdn rtc hospice nf comments 0010.