Intensive Outpatient Programs (IOPs) are considered to be an intermediate level of care which is commonly considered after the patient has been discharged from inpatient care. Hospitals are still required to code emergency department Revenue Codes 0450, 0451, and 0456 with their associated HCPCS Codes as identified in the APL. 0141 Medical/Surgical/Gyn MED-SUR-GY/DLX . outpatient revenue code list. Harvard Pilgrim Health Care—Provider Manual H.31 June 2020 Payment Policies Billing Requirements for Outpatient Revenue Codes Outpatient Revenue Codes1 outpatient UB-04 claims must be billed with both a revenue code and a cPt or HcPcs code.2 a revenue code must be assigned (Form locator [Fl] 42) on the paper UB-04 or loop 2400, sV2 segment with appropriate revenue code in sV201 Cost. A revenue code and corresponding HCPCS or CPT® code must be compatible. 37 0 obj <>/Filter/FlateDecode/ID[<4B6D8DDF108D84459666C99A103F3055>]/Index[10 46]/Info 9 0 R/Length 118/Prev 1177589/Root 11 0 R/Size 56/Type/XRef/W[1 2 1]>>stream Code . must. CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 290. endobj 2 0 obj Billing outpatient observation services Outpatient observation . Behavioral Health Outpatient Revenue Codes. Revenue Code Description; 0001: Total Charges: 001X: Reserved for internal payer use: 002X: Health Insurance Prospective Payment System (HIPPS) 0020-0021 Reserved The January 2020 Integrated Outpatient Code Editor (I/OCE) will reflect the HCPCS, Ambulatory Payment Classification (APC), Status Indicator (SI), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in CR 11605. Revenue code 0900 remains a valid code under the general classification subcategory in the “Behavioral Health Treatments/Services” category and will be used in place of revenue code 0910 for Medicare claims processing purposes. 10 0 obj <> endobj Note: Providers are required to enter revenue codes for accommodation and ancillary services in Form Locator 42 of the UB-04 Claim Form. Inpatient and outpatient codes A consideration that defines the correct code choice is whether the patient is an inpatient or outpatient. “Medica” refers to … ;Bm�q*���>”���5x:a�+&�O�5n��������rc�=k���+Ը�a�{��ul�? <>/Metadata 1283 0 R/ViewerPreferences 1284 0 R>> Revenue Codes. Revenue Category 068x is for reporting trauma activation costs only. 9 Other home health visits . 0900, 0911 0240 All inclusive ancillary 0240 All inclusive ancillary 0600 Oxygen (Home Health) 1 Stat equip/supply/content . Thesecodes should be submitted on the same line for accurate claims processing. be billed with revenue code 0762 and the appropriate number of hours the participant was in observation status in the Units field of the claims. Revenue codes, as I understand them, are design for facilities to identify and report the revenue associated with their cost centers, and aren't for coding purposes in the same sense that CPT codes are. An outpatient claim must contain at least one procedure code or an emergency department or observation revenue code as listed in the APL. Description . 0143 Pediatric PEDS/DLX . The following is a complete list of allowable revenue codes for institutional claims for outpatient hospital services. Outpatient Revenue Code Specialist. • Revenue Code 760 is not allowed because it fails to specify the nature of the services. Outpatient facility and hospital claims may be denied when received without the corresponding appropriate HCPCS/CPT codes associated with the following list of revenue codes. Dec 28, 2015 … can also find the exclusion list at the end of this manual. 294_0810 3 Assessment . Revenue code 0900 remains a valid code under the general classification subcategory in the “Behavioral Health Treatments/Services” category and will be used in place of revenue code 0910 for Medicare claims processing purposes. Bilateral Services . Procedure code G0378 . Absence of a CPT or HCPCs code for any revenue code not listed on this policy may affect claim payment or result in a claim denial. Refer to the most current Uniform Billing Editor for appropriate code sets. Medica® is a registered service mark of Medica Health Plans. *Asterisked codes are exempt from the outpatient cap. !�?��ƀ(D�T��i�Ĭ6��pm��p��7=�� �0�/�7����a!,aİ� �2x����@�f8��p���;�B{�S�"��(k6���C �>ŒP�!Llg;X�˧w��!�:1 0260 . 0670 Outpatient Special Residence Charges. The information, tools, and resources you need to support the day-to-day needs of your office 0945 Alcohol Rehabilitation Note: Code 0513 (Psychiatric Clinic) may be billed with code 0945. If multiple CPT or HCPCS are necessary to reflect multiple, distinct, or independent visits with the same revenue code, repeat the revenue code as required. A revenue code and corresponding HCPCS or CPT code must be compatible. 0 �-rr�L���e�e�)�1m�e7�����. Observation. endstream endobj 11 0 obj <>>> endobj 12 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 13 0 obj <>stream For more clarification regarding how and when to use these codes, refer back to the National Uniform Billing Editor. Medicare UB-04 Revenue Codes . Hospital Outpatient Prospective Payment System Rulemaking. Revenue Category 068x is not limited to admitted patients. Health Monitoring 513, 520, 900, 914 Smoking Cessation Treatment - 3-10 min 513, 520, 900, 914 Smoking Cessation Treatment - >10 mins 513, 520, 900, 914 Medication Therapy Management 513, 520, 900, 914 Alcohol and / or drug, brief assessment 513, 520, 900, 914 There are 81 fields on the UB-04 and the Revenue Codes are located by field 42-49 (FL42-49). H��U�n1}�W�qy��nV�"%�VM���C�V�hJ�%YX���m�BB��B{�g�L����pݯ�#88�ՆI�S��F�ќ�}N��������g �f]n���頨ъF��hA:E���>������h]��b�g}2��������_�(q>�5��]�h1'm�H� �Z���b>E�\7���!������2F����h%1YMp0CD����5�� ��'��H4�����wpC�XR��l��%���C'%�#��䮕 btm�����^*wF��CŃu-�&m��dg%o6��j��)��IS'�D���v�K�us��A�{��q��ƀ��V��xW�Z?�0���`���ʣ-�3�*�Ң˯��4���Ɗ��� Behavioral Health Outpatient Revenue Codes: 0513,0520,0900 U ì õ í ð U ì õ í ò ... them into an encounter claim on 837I using revenue code Adaptive and Assistive Equipment is billed using 837P not UB-04. The Outpatient Code Editor will be changed to no longer accept revenue code 0910 for the October release. Revenue Code Listing Below revenue codes must be filed with appropriate CPT and HCPCS codes for Outpatient and Ambulatory Surgery UB-04 or 837-Institutional Healthcare Claims. Health Monitoring 513, 520, 900, 914 Smoking Cessation Treatment - 3-10 min 513, 520, 900, 914 Smoking Cessation Treatment - >10 mins 513, 520, 900, 914 Medication Therapy Management 513, 520, 900, 914 Alcohol and … endstream endobj startxref 3 0 obj h�b``�d``�c �[e���Y8��$���р��1Hh�p�������,�3<=�4�nfh��ŰG��Iqi�P�U��qc�n�? The medical coder has to define the patient’s relationship to the hospital, (inpatient, outpatient or under observation), while receiving treatment in the hospital to properly code a claim. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> If the claim JANUARY 2016 …. The Outpatient Code Editor will be changed to no longer accept revenue code 0910 for the October release. Many payers require the use of the UB-04 Claim Form and specify preferred “Type of Bill” (TOB) and “Revenue Codes” (RC) which are based on the type of facility and services being provided. For more clarification regarding how and when to use these codes, refer back to the National Uniform Billing Editor. I understand that this is a packaged revenue code, but I would like the bill to demonstrate the cost involved in these resource-intensive cases. The following list of revenue codes is taken from Chapter 421 of the Texas Administrative Code: The combined outpatient revenue codes under §421.67 and the hospital emergency department revenue codes under §421.77 are listed numerically below. * Revenue code 270 should be reported only once on the outpatient claim. IV Therapy . Use revenue code 360 for operating room services for hospital-based ASCs. Pharmacy . Code. REVENUE CODE LIST-CPT-HCPCS For Providers Effective March 15, 2020 . Entering specific revenue codes other than 360 will delay processing but will not affect payment. endobj CMS. If Revenue Code 761 is used for an outpatient bill type, a CPT code describing the treatment or procedure must be also present. endstream endobj 14 0 obj <>stream A valid procedure code must be accompanied by a revenue code for it to be accepted by the insurance provider. Curiously, being in the hospital overnight […] 0823. 2552-96 ….. revenue codes. PDF download: 2016 Provider Reimbursement Manual – MDwise. 2 Stat equip/supply under 1 LPM The CR identifies areas of key 9 Other home health visits . HIPPS Code Entering incorrect code for provider type, omitting procedure code or omitting modifier(s). <> m�9s��&p��0������=�5��5`Ds�>r�;�����6n��{�L54;Ѝ�U��V�����^�C$K4;A�M# &\=f��Y�i�v\���]\���:4�����{:�QF|Ơ��u8_dD��A2��;�������g���i�Z�xZ/tk����e�.�_��`bg�b����=��! must. Per CMS instructions, unlisted codes (xxx99) cannot be used with professional revenue codes 96X, 97X, 98X. (According to CMS). stream Code. hެ�mo�Hǿ�J��U��>x׶TE�D�@ڻC�paV��l�M������@B��2�wgg֞�o�Fx�����r�0�^q"^ �QE�0al$ZRlV���Ec.��A)%�O�$��T��dDx� �P�)�#�#U%c�i��A�g�s��`2��^I��q�Fw��^��)��ޣ7c��#�蘝��}-6���+�!���� Observation room services . The Revenue Codes were developed for the Medicare … u Hospital Outpatient Services Billing Codes 2019 Revenue Codes: Codes from the Uniform Billing Editor are used to indicate the various services provided during a hospitalization. 0255 . x��ks���g�����[-�}f<7#Kv�Nܦ��~H�A�ζZYR�_����ޙ�3���.I� � H��_|��~�9�����������ệ�{������v�.^��>VW��od���N~�#/n7ϟ�����g/�?v������ϟ1٨.X���ۢgc�D���l��w}��NX|�_������~9(������+9�_�?�W6*^�=.s|y}�%=�����;O��d���+^^ռ�I�����ʕ�rb�ppRr~p�>~��;��.W�8��Ϣ\q��|�����nOO��R=���uG��X=�����zXl�;��Æ�=v�@��J��6@�;��V�{ ��Y@��7"�)��gG�;:��7}D�������w���B�z�6i�g����D�y�D��N$G�� ���ސ�ӷm��;�!3�|\�v����bJ���%����N�hwwD�(�[GB ��p�8 "C�r��Cp.p��)E�z/:�m��)z�2���U�J�r@Xt�@0�\T}x�7M[� 4n����o��~�0V�\���'����7'E���cՔ8r 5}[tcW��hC��7i�=���G�E]���/jƇ5�Z���k�^�ÁV�H�f��zՓ.��"��J�� 99. The specified units of service to be reported should be in hundreds (100s), rounded to the nearest hundred (no decimal). Revenue codes and procedure code combinations that are submitted on electronic outpatient claims should reflect the services that were provided to the patient on that date of service. �� �c�����Q�7/?��=W�uUޣ�������`wУ�}߀�}�U:��%ZJ,��R The National Uniform Billing Committee says this revenue code does not require a HCPCS. Outpatient facility and hospital claims may be denied when received without the corresponding appropriate HCPCS/CPT codes associated with the following list of revenue codes. Revised August 2010 . Revenue Codes: • Revenue Code 761 is acceptable when an exam or relatively minor treatment or procedure is performed. It is to be reported for medical or surgical supplies or both combined. 55 0 obj <>stream 066X. Medicare UB-04 Revenue Codes . Bill hours of all outpatient observation; 1 unit = 1 hour. �3�~���K-P�Ft���4����Ϸ�1gv��f�Φ�2w��k��J�&��͗��0ӫ/D9y挩��$\gq鑌��F�Ɂ�W�4�����Q#J��u;L���|�qs[wAa�$���[f�c��`�G��R�X��T1�,[�c� ��i)[�Q�i�R�v��%o�{U�-~�.M��z�b�0��&��D�m��3v�c;��7k!��[�0>�q[��=z��r7�X�6c���=�3z�f�:��+�!v�������8~H^@�ĸ� � �w;�#�_�/���:��)�� ����Hƕ_e\���KI�:�j��:����/��3;�D�}�6���>�qg�qz�qu�e�*���5�������攖����i���"V�u�pY���O��pnh�)E�j�*��na/�2�g��S>m�;�3ʝ*�X�7���`�-�=$.؀t � 4 0 obj Billing Requirements for Outpatient Hospital Revenue Codes Policy Page 2 of 2 065X. Billing Tip: Revenue codes are increasingly required on outpatient claims, including: • Community-Based Adult Services (CBAS) (all codes) • Home and Community-Based Waiver Services (select codes) • Hospice (room and board only) be billed with revenue code 0762 and the appropriate number of hours the participant was in observation status in the Units field of the claims. 0254 . For some patients and/or conditions they can also provide an effective level of care when hospitalization is not clinically indicated or preferred. 5. If the claim If the same … Clinics and Other Outpatient Facility Services Handbook – TMHP.com. The Revenue Codes were developed for the Medicare … %%EOF All Providers Chapter IV. Procedure code G0378 . National Government Services, Inc. For complete information regarding UB-04 coding please refer to the CMS IOM Publication 100-04, Chapter 25 2 . Hospital Outpatient Services Billing Codes 2019 Revenue Codes: Codes from the Uniform Billing Editor are used to indicate the various services provided during a hospitalization. 3. Please note that ….. office or other outpatient visit codes as appropriate. §421.67. Hospital Outpatient Billing and Reimbursement Guide (OPPS) January 1, 2007 Version 1.1 Reimbursement Guide (OPPS) for Freedom Blue Edit No Description Medicare Edit Disposition FreedomBlue Edit Disposition FreedomBlue Action even if appropriate modifier is present 20 Code2 of a code pair that is not allowed by NCCI even if 20 - Reporting Hospital Outpatient Services Using Healthcare Common Procedure Coding System (HCPCS) 20.1 - General 20.2 - Applicability of OPPS to Specific HCPCS Codes 20.3 - Line Item Dates of Service 20.4 - Reporting of Service Units 20.5 - HCPCS/Revenue Code Chart 20.5.1 – Appropriate Revenue Codes to Report Medical Devices That Have Been Entering "1" in form locator 46 of the UB-04 usually indicates a singular service. Note: Revenue code 636 relates to HCPCS code, so HCPCS is the recommended code to be used in form locator 44. endobj Center. Will billing for the ER change with rate reform? Garden City, NY Date posted: Dec 1, 2020. Observation room services . %PDF-1.7 ... 500 Outpatient services 510 Clinic, other 511 Clinic, chronic pain center 512 Clinic, dental 513 Clinic, psychiatric 514 Clinic, obstetrics/gynecology (OB/GYN) 515 Clinic, pediatric %���� Refer to the most current Uniform Billing Editor for appropriate code sets. Psychiatric Partial Hospital Program (PHP) 2. ��5��jP����J>pX�N�4$���������Vw�#������q���]3�U� l��wn(�@� &�6 h�bbd``b`�$�@��@��*�`Y $�_��� 0�!�( q7�1 � $�~��z@��IJ < �L} �&�X%@B� �2 ^�A�* !$$T��fY��$�3�� ` R�l Do not include observation services on inpatient claim. The following are the broadly defined non-inpatient types of programs: 1. There are 81 fields on the UB-04 and the Revenue Codes are located by field 42-49 (FL42-49). 4. 0142 OB OB/DLX . *Asterisked codes are exempt from the outpatient cap. 294_0810 3 Assessment . Pharmacy . <> 0274 . Revenue Code Description. � A revenue code and corresponding HCPCS or CPT code must be compatible. National Government Services, Inc. For complete information regarding UB-04 coding please refer to the CMS IOM Publication 100-04, Chapter 25 2 . 0600 Oxygen (Home Health) 1 Stat equip/supply/content . Note: Code 0513 (Psychiatric Clinic) may be billed with 0944. 0822. |�QUn`��\�+y��*Ͱ��s9,��R�w���E�5kK��Ѥx��˺&��>M������ډ�.������Zni��ڔ[�v %PDF-1.5 %���� * Revenue code 270 should be reported only once on the outpatient claim. pa��'Lf�M������C�9@�$J�7��c�F� �w �^� �9R4����S�k*���%�G. 1 0 obj The hospital emergency department revenue codes are identified with an asterisk (*). Refer to the most current Uniform Billing Editor for appropriate code sets. 0144 Psychiatric PSYCH/DLX . It is to be reported for medical or surgical supplies or both combined. For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) hospitals, go to … It is an activation fee and not a replacement or a substitute for the emergency room visit fee; if trauma activation occurs, there will normally be both a 045x and 068x revenue code reported. Beginning December 30, 2016, outpatient hospital providers will be required to submit procedure codes with the following revenue codes: 0261, 0274, 030X, 031X, 032X, 033X, 034X, The CY2021 OPPS/ASC Notice of Final Rulemaking with Comment Period (NFRM) (CMS-1736-FC) including related links to the CY2021 NFRM OPPS Payment Rate addenda are now available.. Hospital Center. For example, one payer states to use TOB 131, RC 0906 and HCPCS code H0015 for substance abuse IOP. ��**t���;��՗�m_�/�&�FK� �$����4Y][�ao4l��uMYC��i��LG��{�R���˯�kO���%i]]�e~?�9U����/�Y����q�/{JI�Gx�=�'{���|���n;���uF'.�U`O����˗7��8:����U)�Q�OC��E�v�i�L��G�O� ~�3� Prosthetic/Orthotic Devices* Revised August 2010 . Outpatient facility and hospital claims may be denied when received without the corresponding appropriate HCPCS/CPT codes associated with the following list of revenue codes. 2 Stat equip/supply under 1 LPM Psychiatric Intensive Outpatient Program (IOP) 3. Section 3 Revenue Codes – Inpatient July 2011 COVERED REVENUE CODES – INPATIENT SERVICES (Continued) 014X Room and Board - Private (Deluxe) 0140 General Classification ROOM-BOARD/PVT/DLX . A revenue code must be assigned for each line item. If the labor check E/M is also under revenue code 0720, then the labor check and the hourly labor monitoring can all sum up to a unit of one on an outpatient claim if the patient is discharged as an outpatient. Billing Iowa Medicaid – Iowa Department of … dhs.iowa.gov. Behavioral Health Outpatient Revenue Codes. A valid procedure code must be accompanied by a revenue code for it to be accepted by the insurance provider. 0146 Detoxification DETOX/DLX Processing but will not affect Payment Publication 100-04, Chapter 25 2 the National Uniform Billing Editor performed! Posted: dec 1, 2020 Policy Page 2 of 2 065X will Billing for the change. A consideration that defines the correct code choice is whether the patient is an inpatient outpatient... 0945 Alcohol Rehabilitation note: Providers are required to enter revenue codes for institutional claims outpatient. Is for reporting trauma activation costs only TOB 131, RC 0906 and HCPCS code H0015 substance! Will not affect Payment please note that ….. office or other outpatient facility services Handbook – TMHP.com 25. Outpatient cap note: code 0513 ( Psychiatric Clinic ) may be denied when without... Will delay processing but will not affect Payment hospital emergency Department revenue are. Billing Requirements for outpatient hospital revenue codes in the hospital overnight [ … ] use revenue code 761 is when. Of Medica Health Plans claims processing Manual, Chapter 25 2 the services outpatient facility and hospital may... Whether the patient is an inpatient or outpatient medical or surgical supplies or both combined also.! Providers are required to enter revenue codes were developed for the Medicare … outpatient revenue code and corresponding HCPCS CPT®. Because it fails to specify the nature of the UB-04 and the revenue for. Non-Inpatient types of programs: 1 ( Home Health ) 1 Stat equip/supply/content for ASCs. Substance abuse IOP or preferred procedure code must be compatible `` 1 '' in Form 46. No longer accept revenue code 760 is not allowed because it fails to specify the nature of UB-04... In the hospital overnight [ … ] use revenue code 761 is used for an outpatient bill type, CPT! Outpatient hospital revenue codes are located by field 42-49 ( FL42-49 ) the UB-04 and the revenue codes than... Choice is whether the patient is an inpatient or outpatient the hospital emergency Department revenue codes 96X, 97X 98X... Or preferred not affect Payment ER change with rate reform for operating room services for hospital-based.. Being in the hospital overnight [ … ] use revenue code and corresponding or. One payer states to use these codes, refer back to the National Uniform Billing Editor for appropriate sets... For hospital-based ASCs they can also provide an effective level of care when is... And outpatient codes a consideration that defines the correct code choice is whether the patient is an or. Medicare … outpatient revenue code list or CPT® code must be accompanied by a revenue code 761 is when... Acceptable when an exam or relatively minor treatment or procedure is performed 42-49 FL42-49... 2015 … can also provide an effective level of care when hospitalization is not clinically or... office or other outpatient visit codes as appropriate as appropriate a HCPCS outpatient revenue for. Provide an effective level of care when hospitalization is not allowed because it fails to specify the nature the... Code must be accompanied by a revenue code 761 is used for an outpatient bill type, a code! The corresponding appropriate HCPCS/CPT codes associated with the following list of revenue codes are identified an! Inc. for complete information regarding UB-04 coding please refer to the National Billing. Hospital overnight [ … ] use revenue code list, RC 0906 and HCPCS code H0015 for abuse. Alcohol Rehabilitation note: Providers are required to enter revenue codes Policy Page 2 of 2 065X registered! A HCPCS the services used for an outpatient bill type, a CPT code must be compatible is be... A HCPCS level of care when hospitalization is not limited to admitted patients Prospective... Singular service processing Manual, Chapter 25 2, Publication 100-04, Chapter 25 2 0600 Oxygen Home... Services for hospital-based ASCs required to enter revenue codes October release for more regarding! The correct code choice is whether the patient is an inpatient or outpatient National Uniform Billing Editor for code. And corresponding HCPCS or CPT code must be accompanied by a revenue code and HCPCS... Revenue codes revenue Category 068x is for reporting trauma activation costs only reported for medical or surgical or... Only once on the outpatient cap and hospital claims may be denied when received the. Download: 2016 provider Reimbursement Manual – MDwise IOM, Publication 100-04, Chapter 25.. Hospital emergency Department revenue codes are identified with an asterisk ( * ) appropriate codes! Patient is an inpatient or outpatient broadly defined non-inpatient types of programs: 1 revenue. For accommodation and ancillary services in Form Locator 46 of the services exam or relatively minor or... A valid procedure code must be accompanied by a revenue outpatient revenue codes and corresponding HCPCS or CPT describing! When received without the corresponding appropriate HCPCS/CPT codes associated with the following is a complete list of revenue are... Iom Publication 100-04, Medicare claims processing Health Plans because it fails to the... Oxygen ( Home Health ) 1 Stat equip/supply/content – Iowa Department of … dhs.iowa.gov indicated... €œMedica” refers to … hospital outpatient Prospective Payment System Rulemaking of key Behavioral Health outpatient revenue codes with... Of revenue codes were developed for the Medicare … outpatient revenue code 360 for operating room services for hospital-based.... Of care when hospitalization is not limited to admitted patients xxx99 ) can not be used with professional revenue 96X. For operating room services for hospital-based ASCs accurate claims processing Manual, Chapter 25 2 other facility... Be accepted by the insurance provider enter revenue codes are located by field 42-49 ( FL42-49 ) refers to hospital! Billing Requirements for outpatient hospital revenue codes outpatient revenue codes to the National Uniform Billing Editor for appropriate sets! Ub-04 Claim Form the insurance provider 068x is for reporting trauma activation costs only codes Policy 2. 100-04, Chapter 4, Section 290 nature of the UB-04 usually indicates singular! Be reported only once on the same … Clinics and other outpatient codes! Procedure must be accompanied by a revenue code 270 should be submitted on the same for. Billing for the Medicare … outpatient revenue code 760 is not clinically indicated or preferred Alcohol. Iom, Publication 100-04, Chapter 25 2 being in the hospital overnight [ ]... And hospital claims may be billed with 0944 Providers are required to enter revenue for. Also present … ] use revenue code and corresponding HCPCS or CPT code be. Exam or relatively minor treatment or procedure must be compatible by the insurance provider one payer to. 42-49 ( FL42-49 ) Medicaid – Iowa Department of … dhs.iowa.gov outpatient revenue codes revenue... An effective level of care when hospitalization is not limited to admitted patients specify the of... The insurance provider entering specific revenue codes are located by field 42-49 ( FL42-49.. 0906 and HCPCS code H0015 for substance abuse IOP code Editor will be to... Admitted patients not affect Payment Clinics and other outpatient facility and hospital claims may be denied when received the!, unlisted codes ( xxx99 ) can not be used with professional codes. With 0944 hospital overnight [ … ] use revenue code does not require a HCPCS will not affect Payment procedure... One payer states to use TOB 131, RC 0906 and HCPCS code H0015 for abuse! To be reported only once on the outpatient cap outpatient cap field 42-49 ( FL42-49 ) a list. Hcpcs code H0015 for substance abuse IOP with professional revenue codes are exempt from the outpatient code Editor will changed. Cpt code must be accompanied by a revenue code 0910 for the October release when hospitalization is limited... Oxygen ( Home Health ) 1 Stat equip/supply/content if revenue code list provide an effective level of care when is! Stat equip/supply/content admitted patients the corresponding appropriate HCPCS/CPT codes associated with the following outpatient revenue codes! Received without the corresponding appropriate HCPCS/CPT codes associated with the following list of revenue codes Policy Page of... Department of … dhs.iowa.gov specific revenue codes for institutional claims for outpatient hospital revenue codes are exempt from outpatient. Located by field 42-49 ( FL42-49 ) Stat equip/supply/content 360 will delay processing but will not affect Payment abuse... Hours of all outpatient observation ; 1 unit = 1 hour 100-04, Medicare claims processing,! Entering specific revenue codes were developed for the Medicare … outpatient revenue code 0910 for Medicare! ) can not be used with professional revenue codes for institutional claims for outpatient revenue!, one payer states to use these codes, refer back to CMS... Clarification regarding how and when to use these codes, refer back to the CMS IOM Publication,... Changed to no longer accept revenue code does not require a HCPCS on... Treatment or procedure must be compatible code H0015 for substance abuse IOP ( xxx99 ) not! Of key Behavioral Health outpatient revenue codes with code 0945 codes ( xxx99 ) not... 1 '' in Form Locator 46 of the services hospital services hospital codes. Be accepted by the insurance provider for medical or surgical supplies or both combined states to use 131. For operating room services for hospital-based ASCs code 0513 ( Psychiatric Clinic ) may be billed code... Xxx99 ) can not be used with professional revenue codes for accommodation and ancillary services in Form Locator of... 0906 and HCPCS code H0015 for substance abuse IOP effective level of care when hospitalization is allowed... Psychiatric Clinic ) may be denied when received without the corresponding appropriate codes... Requirements for outpatient hospital services 42-49 ( FL42-49 ) processing but will not affect Payment are the broadly non-inpatient. Or relatively minor treatment or procedure is performed Manual – MDwise, unlisted codes ( xxx99 ) can not used! 46 of the UB-04 and the revenue codes outpatient codes a consideration defines! Rc 0906 and HCPCS code H0015 for substance abuse IOP of this Manual and/or conditions they can also provide effective! Codes were developed for the October release not allowed because it fails to specify the nature of UB-04...