UB04/CMS1450 Revenue Codes - Group 05
- 0500 General Classification UB04 Revenue Code
- 0509 Other Outpatient Services UB04 Revenue Code
- 050X Outpatient Services UB04 Revenue Code
- 0510 General Classification UB04 Revenue Code
- 0511 Chronic Pain Center UB04 Revenue Code
- 0512 Dental Clinic UB04 Revenue Code
- 0513 Psychiatric Clinic UB04 Revenue Code
- 0514 OB-GYN Clinic UB04 Revenue Code
- 0515 Pediatric Clinic UB04 Revenue Code
- 0516 PEDS CLINIC UB04 Revenue Code
- 0517 Family Practice Clinic UB04 Revenue Code
- 0519 Other Clinic UB04 Revenue Code
- 051X Clinic UB04 Revenue Code
- 0520 General Classification UB04 Revenue Code
- 0521 Clinic visit by member to RHC/FQHC UB04 Revenue Code
- 0522 RURAL/CLINIC UB04 Revenue Code
- 0523 Family Practice UB04 Revenue Code
- 0524 Visit by RHC/FQHC practitioner to a member in a covered Part A stay at the SNF UB04 Revenue Code
- 0525 Visit by RHC/FQHC practitioner to a member in a SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility UB04 Revenue Co
- 0526 Urgent Care Clinic UB04 Revenue Code
- 0527 RHC/FQHC Visiting Nurse Service(s) to a member?s home when in a home health shortage area UB04 Revenue Code
- 0528 Visit by RHC/FQHC practitioner to other non RHC/FQHC site (e.g. scene of accident) UB04 Revenue Code
- 0529 Other Freestanding Clinic UB04 Revenue Code
- 052X Free-Standing Clinic UB04 Revenue Code
- 0530 General Classification UB04 Revenue Code
- 0531 Osteopathic Therapy UB04 Revenue Code
- 0539 Other Osteopathic Services UB04 Revenue Code
- 053X Osteopathic Services UB04 Revenue Code
- 0540 General Classification UB04 Revenue Code
- 0541 Supplies UB04 Revenue Code
- 0542 AMBUL/SUPPLY UB04 Revenue Code
- 0543 AMBUL/MED TRANS UB04 Revenue Code
- 0544 Oxygen UB04 Revenue Code
- 0545 Air Ambulance UB04 Revenue Code
- 0546 Neo-natal Ambulance UB04 Revenue Code
- 0547 Pharmacy UB04 Revenue Code
- 0548 Telephone Transmission EKG UB04 Revenue Code
- 0549 Other Ambulance UB04 Revenue Code
- 054X Ambulance UB04 Revenue Code
- 0550 General Classification UB04 Revenue Code
- 0551 Visit Charge UB04 Revenue Code
- 0552 Hourly Charge UB04 Revenue Code
- 0559 Other Skilled Nursing UB04 Revenue Code
- 055X Skilled Nursing UB04 Revenue Code
- 0560 General Classification UB04 Revenue Code
- 0561 Visit Charge UB04 Revenue Code
- 0562 Hourly Charge UB04 Revenue Code
- 0569 Other Med. Soc. Services UB04 Revenue Code
- 056X Medical Social Services UB04 Revenue Code
- 0570 General Classification UB04 Revenue Code
- 0571 Visit Charge UB04 Revenue Code
- 0572 Hourly Charge UB04 Revenue Code
- 0579 Other Home Health Aide UB04 Revenue Code
- 057X Home Health Aide (Home Health) UB04 Revenue Code
- 0580 General Classification UB04 Revenue Code
- 0581 Visit Charge UB04 Revenue Code
- 0582 Hourly Charge UB04 Revenue Code
- 0583 Assessment UB04 Revenue Code
- 0589 Other Home Health Visits UB04 Revenue Code
- 058X Other Visits (Home Health) UB04 Revenue Code
- 0590 General Classification UB04 Revenue Code
- 0599 Units of Service (Home Health): Reserved UB04 Revenue Code
- 059X Units of Service (Home Health) UB04 Revenue Code
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What are UB04 Revenue Codes?
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. Because it serves many payers, a particular payer may not need some data elements. The National Uniform Billing Committee (NUBC) maintains lists of approved coding for the form. All items on Form CMS-1450 are described. The FI must be able to capture all NUBC-approved input data described in section 75 (of the Medicare Claims Processing Manual Chapter 25) for audit trail purposes and be able to pass all data to other payers with whom it has a coordination of benefits agreement.
CMS1450/UB04 Field: 42 - Revenue Code (Required)
The provider enters the appropriate revenue codes to identify specific accommodation and/or ancillary charges. It must enter the appropriate numeric revenue code on the adjacent line in FL 42 to explain each charge in FL 47. Additionally, there is no fixed "Total" line in the charge area. The provider must enter revenue code 0001 instead in FL 42. Thus, the adjacent charges entry in FL 47 is the sum of charges billed. This is the same line on which non-covered charges, in FL 48, if any, are summed. To assist in bill review, the provider must list revenue codes in ascending numeric sequence and not repeat on the same bill to the extent possible. To limit the number of line items on each bill, it should sum revenue codes at the "zero" level to the extent possible.
Source: Adapted from the Medicare Claims Processing Manual Chapter 25 - Completing and Processing the Form CMS-1450 Data Set
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