Medicare UB-04 Revenue Codes

0001 Total Charge

002X HI Prosp Paymt System ? HIPPS

2 SNF PPS (RUG) 3 HH PPS (HRG) 4 IRF PPS (CMG)

0100 All-Inclusive Room & Board/Anc

1 All-Inclusive R&B

0110 Room/Board--PVT

1 Medical/surgical/gyn 2 OB 3 Pediatric 4 Psychiatric 5 Hospice 6 Detoxification 7 Oncology 8 Rehabilitation 9 Other

0120 Room/Board--SP 2 bd

1 Medical/surgical/gyn 2 OB 3 Pediatric 4 Psychiatric 5 Hospice 6 Detoxification 7 Oncology 8 Rehabilitation 9 Other

0130 Room/Board-SP 3-4 bd

1 Medical/surgical/gyn 2 OB 3 Pediatric 4 Psychiatric 5 Hospice 6 Detoxification 7 Oncology 8 Rehabilitation 9 Other 0140 Room/Board--PVT Deluxe

1 Medical/surgical/gyn 2 OB 3 Pediatric 4 Psychiatric 5 Hospice 6 Detoxification 7 Oncology 8 Rehabilitation 9 Other

0150 Room/Board--Ward

1 Medical/surgical/gyn 2 OB 3 Pediatric 4 Psychiatric 5 Hospice 6 Detoxification 7 Oncology 8 Rehabilitation 9 Other

National Government Services, Inc.

Medicare UB-04 Revenue Codes

Revised August 2010

0160 Other Room/Board

4 Sterile environment 7 Self Care 9 Other

0180 Leave of Absence

2 Patient Convenience 3 Therapeutic leave 5 Nursing home (for hospitalization) 9 Other

0200 Intensive Care

1 Surgical 2 Medical 3 Pediatric 4 Psychiatric 6 Intermediate--ICU 7 Burn Care 8 Trauma 9 Other Sub-acute Care

0210 Coronary Care

1 Myocardial infarction 2 Pulmonary care 3 Heart Transplant 4 Intermediate--CCU 9 Other

0220 Special Charges

1 Admission 2 Technical support charge 3 U.R. service charge 4 Late discharge--medically necsry 9 Other special charges

0230 Incremental Nursing Care

1 Nursery 2 OB 3 ICU (includes transitional care) 4 CCU (includes transitional care) 9 Other

0240 All Inclusive Ancillary 9 Other All Inclusive Ancillary

0250 Pharmacy

1 Generic drugs 2 Nongeneric drugs 4 Incident to other diagnostic services 5 Incident to radiology 7 Nonprescription 8 IV solutions 9 Other

0260 IV Therapy

1 Infusion pump 2 IV Therapy/ pharmacy services 3 IV Therapy/drug/supply/delivery 4 IV therapy/ supplies 9 Other IV therapy

0270 Medical/Surgical Supplies

1 Nonsterile supplies 2 Sterile supplies

3 Take home supplies 4 Prosthetic/orthotic devices 5 Pacemaker 6 Intraocular lens 7 Oxygen--take home 8 Other implants 9 Other supplies/devices

0280 Oncology

9 Other oncology

0290 Durable Medical Equipment

1 Rental 2 Purchase--new equipment 3 Purchase--used equipment 4 Supplies/drugs for DME (HHA only) 9 Other equipment

0300 Laboratory

1 Chemistry 2 Immunology 3 Renal patient (home) 4 Nonroutine dialysis 5 Hematology 6 Bacteriology/microbiology 7 Urology 9 Other laboratory

0310 Laboratory--Pathology

1 Cytology 2 Histology 4 Biopsy 9 Other

0320 Radiology--Diagnostic

1 Angiocardiography 2 Arthrography 3 Arteriography 4 Chest X-ray 9 Other

0330 Radiology--Therapeutic

1 Chemotherapy--injected 2 Chemotherapy--oral 3 Radiation therapy 5 Chemotherapy--IV 9 Other

0340 Nuclear Medicine

1 Diagnostic procedures 2 Therapeutic procedures 3 Diagnostic radiopharmaceuticals 4 Therapeutic radiopharmaceuticals 9 Other

0350 Computed Tomographic (CT) Scan

1 Head Scan 2 Body Scan 9 Other CT scans

0360 Operating Room Services

1 Minor surgery 2 Organ transplant, other Than kidney 7 Kidney transplant 9 Other Operating Room Services

0370 Anesthesia

1 Incident to radiology 2 Incident to other diagnostic services 9 Other anesthesia

0380 Blood

1 Packed red cells 2 Whole blood 3 Plasma 4 Platelets 5 Leucocytes 6 Other components 7 Other derivatives (cryopricipitates) 9 Other blood

0390 Blood Storage/Processing

1 Blood administration (e.g. transfusion) 2 Processing and storage 9 Other processing & storage

0400 Other Imaging Services

1 Diagnostic mammography 2 Ultrasound 3 Screening mammography 4 PET scan 9 Other imaging services

0410 Respiratory Services

2 Inhalation services 3 Hyperbaric oxygen therapy 9 Other respiratory services

0420 Physical Therapy

1 Visit charge 2 Hourly charge 3 Group rate 4 Evaluation/re-evaluation 9 Other physical therapy

0430 Occupational Therapy

1 Visit charge 2 Hourly charge 3 Group rate 4 Evaluation/re-evaluation 9 Other occupational therapy

0440 Speech-Language Pathology

1 Visit charge 2 Hourly charge 3 Group rate 4 Evaluation/re-evaluation 9 Other speech lang. pathology

0450 Emergency Room

1 ER/EMTALA 2 ER/beyond EMTALA 6 Urgent care 9 Other emergency room

0460 Pulmonary Function

9 Other

For complete information regarding UB-04 coding please refer to the CMS IOM Publication 100-04, Chapter 25

0470 Audiology 1 Diagnostic 2 Treatment 9 Other audiology

0480 Cardiology 1 Cardiac catheter lab 2 Stress test 3 Echo cardiology 9 Other cardiology

0490 Ambulatory Surgery 9 Other ambulatory surgical care

0510 Clinic 1 Chronic pain center 2 Dental clinic 3 Psychiatric clinic 4 OB/GYN clinic 5 Pediatric clinic 6 Urgent care clinic 7 Family Clinic 9 Other clinic

0520 Free-Standing Clinic 1 Rural health clinic 2 Rural health home 3 Family practice clinic 4 RHC/FQHC practitioner visit (Part A

covered stay at a SNF) 5 RHC/FQHC practitioner visit

(Noncovered Part A Stay SNF/NF/ ICF MR or other residential facility) 7 RHC/FQHC Visiting Nurse services(s) to a member's home in a HH shortage area 8 RHC/FQHC practitioner to other non RHC/FQHC site 9 Other

0530 Osteopathic Services 1 Osteopathic therapy 9 Other osteopathic services

0540 Ambulance

0550 Skilled Nursing 1 Visit charge 2 Hourly charge 9 Other skilled nursing

0560 Medical Social Services 1 Visit charge 2 Hourly charge 9 Other medical social services

0570 Home Health Aide 1 Visit charge 2 Hourly charge 9 Other home health aide

0580 Other Visits-HHA 1 Visit charge 2 Hourly charge

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Medicare UB-04 Revenue Codes

Revised August 2010

3 Assessment 9 Other home health visits

0600 Oxygen (Home Health)

1 Stat equip/supply/content 2 Stat equip/supply under 1 LPM 3 Stat equip/supply/ over 4 LPM 4 Portable add-on

0610 Magnetic Resonance Tech. (MRT)

1 Brain (including brainstem) 2 Spinal cord (including spine) 4 MRI--other 5 MRA--head and neck 6 MRA--lower extremities 8 MRA--other 9 MRT - other

062X Med--Surg. Supplies Ext. of 270

1 Incident to radiology 2 Incident to other diagnostic service 3 Surgical dressings 4 Investigational device (IDE)

063X Pharmacy ? Extension of 025X

1 Single source drug 2 Multiple source drug 3 Restrictive prescription 4 EPO less than 10,000 units 5 EPO 10,000 or more units 6 Drugs requiring detailed coding 7 Self administrable drugs (insulin admin

in emergency-diabetic coma)

065X Hospice

1 Routine Home Care 2 Continuous Home Care 5 Inpatient respite care 6 General inpatient care (non-respite) 7 Physician services 8 Hospice room & board--nursing facility 9 Other hospice

068X Trauma Response

1 Level I 2 Level II 3 Level III 4 Level IV 9 Other trauma response 0700 Cast room________________

0710 Recovery Room____________

0720 Labor Room

1 Labor 2 Delivery 4 Birthing center 9 Other labor room/delivery

0730 EKG/ECG

1 Holter monitor 2 Telemetry 9 Other EKG/ECG 0740 Electroencephalogram EEG 0750 Gastro-Intestinal Services

0760 Specialty Services 1 Treatment room 2 Observation hours 9 Other specialty services

0770 Preventive Care Services

1 Vaccine administration 0780 Telemedicine 0790 Extra-Corporeal Shock Wave Therapy (formerly Lithotripsy)

0800 Inpatient Renal Dialysis

1 Inpatient hemodialysis 2 Inpatient peritoneal (non-CAPD) 3 Inpatient CAPD 4 Inpatient CCPD 9 Other inpatient dialysis

081X Organ Acquisition

1 Living donor 2 Cadaver donor 3 Unknown donor 4 Unsuccessful organ search donor bank

Charge 9 Other organ donor

082X Hemodialysis ? Outpatient/Home

1 Hemodialysis composite or other rate 2 Home supplies 3 Home equipment 4 Maintenance/100% 5 Support services 9 Other hemodialysis outpatient

083X Peritoneal OPD/Home

1 Peritoneal/composite or other rate 2 Home supplies 3 Home equipment 4 Maintenance/100% 5 Support services 9 Other peritoneal dialysis

084X CAPD OPD/Home

1 CAPD/composite or other rate 2 Home supplies 3 Home equipment 4 Maintenance/100% 5 Support services 9 Other CAPD dialysis

0850 CCPD - Outpatient

1 CCPD/composite or other rate 4 Maintenance/100% 5 Support services 9 Other CCPD dialysis

0880 Miscellaneous Dialysis

1 Ultra-filtration 9 Other miscellaneous dialysis

0900 Behavioral Health Treatment/Services

1 Electroshock treatment 2 Milieu therapy 3 Play therapy 4 Activity therapy 5 Intensive outpatient serv--psychiatric 6 Intensive out serv--chem dependency 7 Community behavioral health program

(day treatment)

091X Behavioral Health Treatment/ Services ? Ext of 090X

1 Rehabilitation 2 Partial hospitalization--less Intensive 3 Partial hospitalization--Intensive 4 Individual therapy 5 Group therapy 6 Family therapy 7 Bio Feedback 8 Testing 9 Other behavioral treatments/services

0920 Other Diagnostic Services

1 Peripheral vascular lab 2 Electromyelogram 3 Pap smear 4 Allergy test 5 Pregnancy test 9 Other diagnostic services

940 Other Therapeutic Service

1 Recreational therapy 2 Education/training (includes diabetes

related dietary therapy) 3 Cardiac rehabilitation 4 Drug rehabilitation

5 Alcohol rehabilitation 6 Complex medical equipment routine 7 Complex medical equipment ancillary 9 Other therapeutic services

0960 Professional Fees

1 Psychiatric 2 Ophthalmology 3 Anesthesiologist (MD) 4 Anesthetist (CRNA) 9 Other professional fees

097X Professional Fees - Ext of 096X

1 Laboratory 2 Radiology--diagnostic 3 Radiology--therapeutic 4 Radiology--nuclear medicine 5 Operating room 6 Respiratory therapy 7 Physical therapy 8 Occupational therapy 9 Speech pathology

098X Professional Fees - Ext of 096X & 097X

1 Emergency room 2 Outpatient services 3 Clinic 4 Medical social services 5 EKG 6 EEG 7 Hospital visit 8 Consultation 9 Private duty nurse

National Government Services, Inc.

For complete information regarding UB-04 coding please refer to the CMS IOM Publication 100-04, Chapter 25

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