2013 ub 04 manual revenue codes

Required required revenue code for inpatient billing, enter the four. The security health plan processing system is designed to process standard health insurance claim forms ub04 using revenue codes. Center for health statistics hospital and patient data systems. Official ub 04 data specifications manual 2020 author. Refer to the pregnancy sections of this manual for detailed policy information. Revenue code descriptionide numbermedicaid drug rebate 123 an.

A valid procedure code must be accompanied by a revenue code for it to be accepted by the insurance provider. Updated revenue description of 0331 and 0335 to match the description listed in the aha manual. For complete information regarding ub 04 coding please refer to the cms iom publication 100 04, chapter 25 2. Changed reference to claim form from ub 92 to ub 04. Revenue code r enter the applicable revenue code for the services rendered. If highmark audits find professional services are billed in error on 837iub04 claims. Npi some facilities may have several npi numbers i.

Refer to the ub 04 billing manual for more information on value codes. Refer to form locator 80 for adjustment reason codes. General billing instructions idaho medicaid health pas online. There are 81 fields on the ub 04 and the revenue codes are located by field 4249 fl4249. Enter the code from the list of occurrence codes listed in the code sets for the ub 04 do not include revenue codes for roomandboard charges incurred on. Effective october 1, 20, highmark expanded the application of the ncci edits to. To view a sample residential health care ub04 claim form, see.

If applicable, enter the appropriate code from the nubc ub 04 manual, form locator 3941 to indicate that one or. Multiple units of the same service code modifier on the same day must value codes and the ub04 must be submitted on paper and list occurrence code a3 dhmp commercial ub04 billing manual denver health medical ub04 dhmp billing manual. Comprehensive hospital abstract reporting system chars procedure manual for submitting discharge data ub 04 and 837i 5010 effective january 28, 2011 revised september21, 20 revised january 30, 2014 for more information contact. Ub 04 billing guide for promise icfmr, icforcs and state mr centers purpose of the. Bill the 0169 revenue code for the noncase mix element direct care addon. Aarp health insurance plans pdf download medicare replacement pdf download aarp. Completion of ub 04 for hospital inpatientoutpatient services the uniform bill for institutional providers is the ub 04 cms1450. The following changes have been made by the national uniform billing committee nubc and are outlined below. Ub04 billing instructions guide health pasonline maine. Ub04 revenue codes icd 10 codes, cpt codes, hcpcs codes. Refer to the pathology sections of this manual for policy information related to these examples. Examples in this section are to help providers bill pregnancy services on the ub 04 claim form. Revenue description enter the standard abbreviated description of the related revenue code categories included on this bill. Code structure 2nd digittype of facility cms will process this as the 1st digit 3rd digitbill classification except clinics and special.

Because it serves many payers, a particular payer may not need some data elements. When billing for these services, hospitals should use revenue codes in the. Revenue code list with description medicare payment. Health first colorado ub04 inpatientoutpatient billing. R2683cp 040520 nonsystems internet only manual iom. Refer to the health first colorado ub04 revenue code table. Revenue descriptionr enter the applicable revenue code. October 1, 2006 to december 31, 20 cmsdrg version 24. The displayed claim form is a sample and is for illustration. Please see the resources page for more information on where to purchase cms1500 forms. Audiology billing manual or the laboratory billing manual under cms 1500 for more information. Chemotherapy coding hawaii medical service association. This form, also known as the ub 04, is a uniform institutional provider bill suitable for.

It is important to bill with the correct npi for the service you. Health first colorado ub04 inpatient outpatient billing manual. Completing the ub04 claim form guidelines for facility. Patients relationship to insured see the ub 04 manual for the 2digit. The revenue codes were developed for the medicare system but. Enter code 001 in the revenue code column box 42, line 23 to designate that this is. Revenue code enter the applicable revenue code for the services rendered. Completing the ub 04 claim form guidelines for facilityinstitutional providers medica follows national and state uniform billing guidelines for the submission of ub 04 claim forms, although some fields required by medicare or other payers may not be necessary for medica claims.

This manual, ed by the american hospital association, is the only official source of ub data. New ub 04 cms 1450 claim instructions for personal care services wisconsin medicaid will begin accepting the new ub 04 cms 1450 claim form. Enter the appropriate fourdigit revenue code as defined by the nubc that identifies a specific accommodation or ancillary. Ub04 cms 1450 claim form instructions for nursing home. Revenue codes are not to be indicated for outpatient services. To view a sample cmcm ub 04 claim form, see appendix a. Oct 1, 2015 does the hospital have to submit the aprdrg on the ub 04 paper form or the 837i. It is to be used as a companion to, and not a replacement for, the ub 04 data specifications manual, available from the national uniform billing committee at. Please report applicable revenue code that represent the prospective. Cms has allowed for revenue code 0910 to be used until 10 04 04, when necessary systems changes can be implemented. For nursing facilities, use only the following revenue codes. Understanding hospital revenue codes value healthcare. This fourdigit alphanumeric code gives three specific pieces of information. Form locators 3941 ad value code and amount enter the relevant value code and associated amount, if applicable.

Updated guidance on other implant revenue code 0278 effective july 1, 2020. Sep 18, 2015 manual reflects the changes associated with the ub 04 format. You can access the ub04 billing information adopted by the nubc by. File type pdf ub04 revenue codes 20 emergency renal dialysis must be billed using revenue code 809. Updated guidance on nursery revenue codes 017x effective july. Commonwealth of kentucky ky medicaid provider billing. Instructions for completing the ub04 claim form san francisco. New ub04 cms 1450 claim instructions for personal care. Aarp health insurance plans pdf download medicare replacement pdf.

Can i purchase cms1500 forms from the nubc website. Hmsa has determined that it will use the national uniform billing committee nubc official ub 04 data specifications manual as the standard source for codes and code descriptions to be entered in the various form locators fl. Ub 04 revenue codes for providersnumeric listing 0001 total charges. Page i add transition management to the list of services policies. Refer to the health first colorado ub04 revenue code table appendix q for a complete listing. Updated guidance on nursery revenue codes 017x effective july 1, 2020. Outpatient services section of this manual for instructions to complete claim fields not explained in the following examples. You can access the ub 04 billing information adopted by the nubc by subscribing to the official ub 04 data specifications manual.

On the paper ub 04 report the total for all revenue codes as page 729. Ub 04 manual for the utah medicaid ub 04 billing instructions. Revenue code description effective from effective through inpatien t outpatient fqhcrhc dialysis hhpdn rtc hospice nf comments 0010. Nys medicaid uses revenue codes to identify the following information. Aug 1, 2011 ub04 forms are for inpatient and outpatient facility claims. Point of origin codes update to the ub 04 cms1450 manual code list national uniform billing committee nubc, will be accepted into the fiscal. Inpatient emergency renal dialysis must be billed using revenue code 809. Room and board private one bed 0111 medicalsurgicalgyn. The chars procedure manual and chars companion guide supplement the national uniform billing committee uniform billing form 2004 nubc ub 04 and the asc x12 standards for electronic data interchange technical report type 3, health care claim.

Please use the national ub 04 manual for specific codes. Nov 15, 20 condition codes ub 04 form locators fls 1828. Chapter 25 completing and processing the form cms1450 data set. Refer to the ub 04 billing manual for more information. Enter a code indicating patient status as of the ending service date of the period covered on the bill, as reported in fl 6, statement covers period. For complete information regarding ub 04 coding please refer to the cms iom publication 100 04. In addition to the national ub 04 manual, in order to complete the ub 04 form, utilize the current cpt current procedural terminology of the american medical association, the current icd international classification of diseases diagnostic codes based on date of service, or hcpcs healthcare common procedure coding system codes. Added zeros before revenue codes to make them 4 digits. Ub04 claim form instructions form locator name instructions 1. The ub04 claim form is used to submit claims for inpatient and outpatient services by.

May 3, 20 the type of bill codes used for home health claims. The type of bill codes and ub 04 claim frequency type code values for. Enter up to one revenue code per line as needed in lines. For more information on revenue codes, refer to the national uniform billing committees official ub 04 data specifications manual. Revenue code enter a four digit revenue code beside each service described in column 43. Special instructions for labor and delivery claims delivery is a benefit for recipients of emergency medicaid, but. In the amount box, enter the number, amount, or ucr value associated with that code. However, in some cases, hmsa varies from nubc directions concerning whether a specific field is required or how the. Form cms1450 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. This manual, ed by the american hospital association, is the only official. Revenue description refer to the ub04 manual for details. Cms1450 ub 04 revenue codes substance use disorder sud inpatient billing per the seri guidelines requires a paring of specific revenue codes with hcpc codes for claims payment under the sud benefit. This form, also known as the ub04, is a uniform institutional provider bill suitable for.