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Revenue Codes

The following is a complete list of allowable revenue codes for institutional claims for outpatient hospital services.

Note: Providers are required to enter revenue codes for accommodation and ancillary services in Form Locator 42 of the UB-04 Claim Form.

Policy

Specific Revenue Codes

Revenue codes that require a service-specific third digit from the UB-04 Billing Manual

011X, 012X, 013X, 015X, 016X, 017X, 020X, 021X, 025X, 036X, 051X, 071X, 090X, 091X, 092X, 094X, 096X

Revenue codes that require a HCPCS or CPT laboratory procedure code for outpatient services in Form Locator 44 of the UB-04 Claim Form

030X, 031X, 0923, 0925

Revenue codes for dental services

0512 (Use when providing dental services as part of an outpatient visit.)

Revenue codes for vision care services

0519 (Use when providing vision care services as part of an outpatient visit.)

Revenue code for outpatient observation room

0710 (Use when member is under observation after recovering from ambulatory surgery.)

Revenue code for observation hours

0762

Revenue code for telehealth services

0780 (Use with HCPCS code Q3014 when submitting claims for telehealth originating site fees.)

Revenue codes exempt from member copayment

0820–0859, 0901, 0918

Note: Revenue code 0253 is exempt from member copayment on crossover claims. Revenue code 0450 is exempt from copayment for outpatient services.

Noncovered revenue codes

0140–0149, 0180–0189, 0220–0221, 0229, 0294, 0374, 0420–0449, 0547–0548, 0550, 0609, 0624, 0637, 0660–0669, 0670–0679, 0880, 0990–0999

Noncovered revenue codes "Reserved for Future Assignment"

0599, 0709, 0719, 0749, 0759, 0779, 0789, 0799

Noncovered revenue codes for psychiatric hospitals

0520, 0529, 0940, 0949

Noncovered revenue codes for general hospitals billing psychiatric or substance abuse services

0520, 0529, 0940, 0949

Nonbillable revenue codes

Nonbillable for bill type 011X: 0100–0101, 0115, 0135, 0155, 0240, 0249, 0253, 0259, 0279, 0291–0293, 0299, 0479, 0530–0531, 0539, 0540–0546, 0549, 0551–0552, 0559, 0570–0572, 0579, 0580–0582, 0589, 0590, 0600–0604, 0650–0657, 0659, 0912–0913, 0960–0964, 0969, 0971–0979, 0981–0989

Nonbillable for bill type 013X: 0180–0240, 0249, 0259, 0279, 0299, 0540–0546, 0549, 0550–0552, 0559, 0570–0572, 0579, 0580–0582, 0589, 0590, 0600–0604, 0650–0657, 0659, 0912–0913, 0990–0999

Billable, noncovered revenue code

0180

Restricted revenue codes

0110–0114, 0116–0117, 0119

Revenue code for medication checks

0510

The following is a list of revenue codes that are exempt from the requirement to have a corresponding HCPCS or CPT code indicated on institutional claims for outpatient hospital services.

Policy

Specific Revenue Codes

Exempt revenue codes

0250, 0251, 0252, 0253, 0258, 0270, 0271, 0272, 0276, 0278, 0370, 0500, 0509, 0521, 0522, 0524, 0525, 0527, 0528, 0583, 0660, 0661, 0662, 0663, 0669, 0710, 0762, 0907, 0931, 0932, 0948, 099X, 100X, 210X, 310X

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Covered and Noncovered Services : Codes

Revenue Codes