Revenue code list with description

UB-04 Revenue Codes for Providers-Numeric Listing

0001 Total Charges
0020 Health Insurance – Prospective Payment System (PPS)
0022 SNF – (PPS)
0023 Home Health – PPS
0024 Inpatient Rehab Facility – PPS
0100 All-inclusive Room & Board & Ancillary
0101 All-inclusive room & board
0110 Room & Board - Private
0111 Medical/surgical/gyn
0112 Obstetrics (OB)
0113 Pediatric
0114 Psychiatric
0115 Hospice
0116 Detox
0117 Oncology
0118 Rehab
0119 Other
0120 Room & Board – Semi-private, 2 Beds
0121 Medical/surgical/gyn
0122 Obstetrics (OB)
0123 Pediatric
0124 Psychiatric
0125 Hospice
0126 Detox
0127 Oncology
0128 Rehab
0129 Other
0130 Room & Board – Semi-private, 3-4 Beds
0131 Medical/surgical/gyn
0132 Obstetrics (OB)
0133 Pediatric
0134 Psychiatric
0135 Hospice
0136 Detox
0137 Oncology
0138 Rehab
0139 Other
0140 Room & Board – Private (Deluxe)
0141 Medical/surgical/gyn
0142 Obstetrics (OB)
0143 Pediatric
0144 Psychiatric
0145 Hospice
0146 Detox
0147 Oncology
0148 Rehab
0149 Other
0150 Room & Board - Ward
0151 Medical/surgical/gyn
0152 Obstetrics (OB)
0153 Pediatric
0154 Psychiatric
0155 Hospice
0156 Detox
0157 Oncology
0158 Rehab
0159 Other
0160 Nursery
0164 Sterile environment
0167 Self care
0169 Other
0170 Nursery
0171 Newborn – Level I
0172 Newborn – Level II
0173 Newborn – Level III
0174 Newborn – Level IV
0179 Other
0180 Leave of Absence
0182 Patient convenience
0183 Therapeutic leave
0185 Nursing Home (for hospitalization)
0189 Other leave of absence
0190 Sub-Acute Care
0191 Level I
0192 Level II
0193 Level III
0194 Level IV
0199 Other sub-acute care
0200 Intensive Care
0201 Surgical
0202 Medical
0203 Pediatric
0204 Psychiatric
0206 Intermediate ICU
0207 Burn care
0208 Trauma
0209 Other

0210 Coronary Care
0211 Myocardial infarction
0212 Pulmonary care
0213 Heart transplant
0214 Intermediate critical care unit (CCU)
0219 Other
0220 Special Charges
0221 Admission
0222 Technical support
0223 UR service
0224 Late discharge – medically necessary
0229 Other
0230 Incremental Nursing Charge Rate
0231 Nursery
0232 Obstetrics (OB)
0233 Intensive care unit (ICU)
0234 Critical care unit (CCU)
0235 Hospice
0239 Other

0240 All-Inclusive Ancillary – General
0241 Basic
0242 Comprehensive
0243 Specialty
0249 Other
0250 Pharmacy
0251 Generic drugs
0252 Non-generic drugs
0253 Take home drugs
0254 Incident to other diagnostic services
0255 Incident to radiology
0256 Experimental drugs
0257 Non-Rx
0258 IV solutions
0259 Other
0260 IV Therapy
0261 Infusion pump
0262 IV therapy/pharmacy services
0263 IV therapy/drug/supply delivery
0264 IV therapy/supplies
0269 Other
0270 Medical/Surgical Supplies and Devices
0271 Non-sterile supplies
0272 Sterile supplies
0273 Take-home supplies
0274 Prosthetic/orthotic devices
0275 Pacemaker
0276 Intraocular lens
0277 Oxygen – take home
0278 Other implants
0279 Other supplies/devices
0280 Oncology
0289 Other oncology
0290 Durable Medical Equipment (not renal)
0291 Rental
0292 Purchase – new equipment
0293 Purchase – used equipment
0294 Supplies/drugs for DME (HHA only)
0299 Other equipment
0300 Laboratory
0301 Chemistry
0302 Immunology
0303 Renal patient (home)
0304 Non-routine dialysis
0305 Hematology
0306 Bacteriology and microbiology
0307 Urology
0309 Other
0310 Laboratory - Pathology
0311 Cytology
0312 Histology
0314 Biopsy
0319 Other
0320 Radiology - Diagnostic
0321 Angiocardiography
0323 Arthrography
0324 Arteriography
0324 Chest X-ray
0329 Other

0330 Radiology - Therapeutic and/or
Chemotherapy Administration
0331 Chemotherapy – injected
0332 Chemotherapy – oral
0333 Radiation therapy
0335 Chemotherapy – IV
0339 Other
0340 Nuclear Medicine
0341 Diagnostic
0342 Therapeutic
0343 Diagnostic radiopharmaceuticals
0344 Therapeutic radiopharmaceuticals
0349 Other
0350 Computerized Tomography (CT Scan)
0351 Head scan
0352 Body scan
0359 Other CT scans

0350 Computerized Tomography (CT Scan)
0351 Head scan
0352 Body scan
0359 Other CT scans
0360 Operating Room Services
0361 Minor surgery
0362 Organ transplant, not kidney
0367 Kidney transplant
0369 Other
0370 Anesthesia
0371 Incident to radiology
0372 Incident to other diagnostic services
0374 Acupuncture
0379 Other

0380 Blood
0381 Packed red cells
0382 Whole blood
0383 Plasma
0384 Platelets
0385 Leukocytes
0386 Other components
0387 Other derivatives (cryoprecipitates)
0389 Other
0390 Blood Storage/Processing
0391 Blood administration
0392 Processing and storage
0399 Other blood handling
0400 Other Imaging Services
0401 Diagnostic mammography
0402 Ultrasound
0403 Screening mammography
0404 Positron emission tomography (PET scan)
0409 Other imaging services

0410 Respiratory Services
0412 Inhalation therapy
0413 Hyperbaric oxygen therapy
0419 Other
0420 Physical Therapy
0421 Visit charge
0422 Hourly charge
0423 Group rate
0424 Evaluation or re-evaluation
0429 Other
0430 Occupational Therapy
0431 Visit charge
0432 Hourly charge
0433 Group rate
0434 Evaluation or re-evaluation
0439 Other
0440 Speech Therapy – Language Pathology
0441 Visit charge
0442 Hourly charge
0443 Group rate
0444 Evaluation or re-evaluation
0449 Other
0450 Emergency Room (ER)
0451 EMTALA emergency medical screening
0452 ER beyond EMTALA screening
0456 Urgent Care
0459 Other emergency room
0460 Pulmonary Function
0469 Other pulmonary function
0470 Audiology
0471 Diagnostic
0472 Treatment
0479 Other
0480 Cardiology
0481 Cardiac catheter lab
0482 Stress test
0483 Echocardiography
0489 Other
0490 Ambulatory Surgical Care
0499 Other
0500 Outpatient Services
0509 Other
0510 Clinic
0511 Chronic pain center
0512 Dental clinic
0513 Psychiatric clinic
0514 OB/Gyn clinic
0515 Pediatric clinic
0516 Urgent care clinic
0517 Family practice clinic
0519 Other clinic
0520 Free-Standing Clinic
0521 Rural health clinic
0522 Rural health – home
0523 Family practice clinic
0524 Rural Health Family Clinic
0525 Rural Health – other residential facility
0526 Urgent care clinic
0527 Rural Health – visiting nurse
0528 Rural Health – other site
0529 Other freestanding clinic
0530 Osteopathic Services
0531 Osteopathic therapy
0539 Other
0540 Ambulance
0541 Supplies
0542 Medical transport
0543 Heart mobile
0544 Oxygen
0545 Air ambulance
0546 Neonatal ambulance services
0547 Pharmacy
0548 Telephone transmission EKG
0549 Other (ALS)
0550 Skilled Nursing
0551 Visit charge
0552 Hourly charge
0559 Other
0560 Home Health - Medical Social Services
0561 Visit charge
0562 Hourly charge
0569 Other
0570 Home Health Aide
0571 Visit charge
0572 Hourly charge
0579 Other
0580 Other Visits (Home Health)
0581 Visit charge
0582 Hourly charge
0589 Other
0590 Units of Service (Home Health)
0600 Oxygen (Home Health)
0601 Oxygen – state/equip/suppt/or cont
0602 Oxygen – state/equip/under 1 LPM
0603 Oxygen – state/equip/over 4 LPM
0604 Oxygen – portable add-on
0609 Other
0610 Magnetic Resonance Imaging (MRI)
0611 MRI brain (including brain stem)
0612 MRI spinal cord (including spine)
0614 MRI – other
0615 MRA – head and neck
0616 MRA – lower extremities
0618 MRA – other
0619 Other
0620 Medical/Surgical Supplies - Extension of
270
0621 Supplies incident to radiology
0622 Supplies incident to other diagnostic
services
0623 Surgical dressings
0624* FDA investigational devices
0630 Drugs Requiring Specification
Identification
0631 Single source drug
0632 Multiple source drug
0633 Restrictive prescription
0634 Erythropoietin (EPO) less than 10,000
units
0635 Erythropoietin (EPO) greater than 10,000
units
0636 Drugs requiring detailed coding
0637 Self-administrable drugs
0640 Home IV Therapy Services
0641 Non-routine nursing/central line
0642 IV site care, central line
0643 IV start/care/peripheral line
0644 Non-routine nursing/peripheral line
0645 Training patient/caregiver/central line
0646 Training disabled patient/central line
0647 Training patient/caregiver/peripheral line
0648 Training disabled patient/peripheral line
0649 Other
0650 Hospice
0651 Routine home care
0652 Continuous home care
0655 Inpatient respite care
0656 General inpatient care (non-respite)
0657 Physician services
0658 Hospice R&B Nursing Facility
0659 Other
0660 General Respite Care (Home Health
Only)
0661 Hourly charge/skilled nursing
0662 Hourly charge/home health aide/
homemaker/companion
0633 Daily Respite Charge
0669 Other Respite
0670 Outpatient Special Residence Charges
0671 Hospital owned
0672 Contracted
0679 Other special residence charges
0680 Trauma Response
0681 Level I Trauma
0682 Level II Trauma
0683 Level III Trauma
0684 Level IV Trauma
0689 Other
0700 Cast Room
0710 Recovery Room
0720 Labor Room/Delivery
0721 Labor
0722 Delivery
0723 Circumcision
0724 Birthing center
0729 Other
0730 EKG/ECG (Electrocardiogram)
0731 Holter monitor
0732 Telemetry
0739 Other
0740 EEG (Electroencephalogram)
0750 Gastrointestinal
0760 Treatment or Observation Room
0761 Treatment room
0762 Observation room
0769 Other specialty rooms
0770 Preventive Care Services
0771 Vaccine administration
0780 Telemedicine
0790 Extra-Corporeal Shock Wave Therapy
0800 Inpatient Renal Dialysis
0801 Hemodialysis
0802 Peritoneal dialysis (non-CAPD)
0803 Continuous ambulatory peritoneal dialysis
(CAPD)
0804 Continuous cycling peritoneal dialysis
(CCPD)
0809 Other
0810 Organ Acquisition
0811 Living donor
0812 Cadaver donor
0813 Unknown donor
0814 Unsuccessful organ search – donor bank
charges
0819 Other donor
0820 Hemodialysis Outpatient or Home
0821 Hemodialysis – composite or other rate
0822 Home supplies
0823 Home equipment
0824 Maintenance – 100%
0825 Support services
0829 Other


0830 Peritoneal Dialysis Outpatient or Home
0831 Peritoneal dialysis – composite or other
rate
0832 Home supplies
0833 Home equipment
0834 Maintenance – 100%
0835 Support services
0839 Other
0840 CAPD (Dialysis) Outpatient or Home
0841 CAPD - composite or other rate
0842 Home supplies
0843 Home equipment
0844 Maintenance – 100%
0845 Support services
0849 Other
0850 CCPD (Dialysis) Outpatient or Home
0851 CCPD – composite or other rate
0852 Home supplies
0853 Home equipment
0854 Maintenance – 100%
0855 Support services
0859 Other
0880 Miscellaneous Dialysis
0881 Ultra-filtration
0882 Home dialysis aid visit
0889 Other
0900 Behavioral Health Treatment
0901 Electroshock treatment
0902 Milieu therapy
0903 Play therapy
0904 Activity therapy
0905 Intensive outpatient services – psychiatric
0906 Intensive outpatient services – chemical
dependency
0907 Community Behavioral Health Program
(Day
Treatment
091X Behavioral Health Treatment -
Reserved
0911 Rehabilitation
0912 Partial hospitalization – less intensive
0913 Partial hospitalization – intensive
0914 Individual therapy
0915 Group therapy
0916 Family therapy
0917 Biofeedback
0918 Testing
0919 Other
0920 Other Diagnostic Services
0921 Peripheral vascular lab
0922 Electromyelgram
0923 Pap smear
0924 Allergy test
0925 Pregnancy test
0929 Other diagnostic service
0930 Medical rehab day program-Reserved
0931 Medical rehab day program – half-day
0932 Medical rehab day program – full-day
0940 Other Therapeutic Services
0941 Recreational therapy
0942 Education/training
0943 Cardiac rehabilitation
0944 Drug rehabilitation
0945 Alcohol rehabilitation
0946 Complex medical equipment – routine
0947 Complex medical equipment – ancillary
0948 Pulmonary rehab
0949 Other therapeutic services
0950 Other therapeutic services – reserved
0951 Athletic training
0952 Kinesiotherapy
0960 Professional Fees
0961 Psychiatric
0962 Ophthalmology
0963 Anesthesia – MD
0970 Professional Fees - Reserved
0971 Laboratory
0972 Radiology – diagnostic
0973 Radiology – therapeutic
0974 Radiology – nuclear medicine
0975 Operating room
0976 Respiratory therapy
0977 Physical therapy
0978 Occupational therapy
0979 Speech therapy
0980 Professional Fees - Reserved
0981 Emergency room
0982 OPD
0983 Clinic
0984 Medical/social services
0985 Electrocardiogram (EKG)
0986 Electroencephalogram (EEG)
0987 Hospital visit
0988 Consultation
0989 Private duty nurse
0990 Patient Convenience Items
0991 Cafeteria/guest tray
0992 Private linen services
0993 Telephone/telegraph
0994 TV/radio
0995 Nonpatient room rentals
0996 Late discharge charge
0997 Admission kits
0998 Beauty shop/barber
0999 Other
1000 Behavioral Health Accommodations
1001 Residential treatment – psychiatric
1002 Residential treatment – chemical
dependency
1003 Supervised living
1004 Halfway house
1005 Group home
2100 Alternative Therapy Services
2101 Acupuncture
2102 Acupressure
2103 Massage
2104 Reflexology
2105 Biofeedback
2106 Hypnosis
2109 Other alternative therapy services
3100 Adult Day Care - Reserved
3101 Adult day care, medical, social – hourly
3102 Adult day care, social – hourly
3103 Adult day care, medical, social – daily
3104 Adult daycare, social – daily
3105 Adult foster care – daily
3109 Other adult care
0964 Anesthesia – CRNA
0969 Other




The following chart identifies revenue codes that require a specific CPT/HCPCS code in field 44 of the UB-04.

Revenue Code        Description           CPT/HCPCS Code

0300 - 0309        Laboratory – Clinical Diagnostic      Code for lab procedure performed

0310 - 0319      Laboratory - Pathology     Code for pathology procedure performed

0320 - 0329           Radiology - Diagnostic      Code for radiology procedure performed

0333                Radiology - Therapeutic   Code for therapeutic radiology procedure performed

0340 - 0349            Nuclear Medicine        Code for nuclear medicine procedure performed

0350 - 0359          CT Scan          Code for CT scan performed

0360 - 0369       Operating Room Services     Code for surgery procedure performed

0400 - 0409       Other Imaging Services     Code for imaging services, such as, mammography, ultrasound, PET, etc.

0450 - 0459         Emergency Room             Code for visit or surgery procedure performed

0460 - 0469              Pulmonary Function        Code for pulmonary function procedure performed

0471                   Audiology                  Code for audiology service performed

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