UB-04 Revenue Codes - Obscure But Still Part of the Game

by  Find-A-Code™
Oct 18th, 2023

Medical coders and billers need to be intimately familiar with common code sets like CPT, ICD-10, and HCPCS. But there are other more obscure code sets as well. They may not be utilized as frequently, but they are still out there. They are still part of the medical coding and billing game. UB-04 revenue codes are a prime example.

UB-04 revenue codes pertain to inpatient hospital services. There are just over 1,000 codes in this set, making the set relatively small when compared against CPT and ICD-10. The codes help payers understand the type of service or product they are being billed for.

Divided Into Groups

As with most other medical code sets, the UB-04 revenue code set is divided into nine groups to make it easier to deal with. All products and services listed on a UB-04 claim form will fall under one of the following group classifications:

• Group 01 – General classification
• Group 02 – Room and board
• Group 03 – Surgical procedures
• Group 04 – Medical procedures
• Group 05 – Laboratory tests
• Group 06 – Imaging services
• Group 07 – Medications
• Group 08 – Supplies
• Group 09 – Durable medical equipment (DME)

In addition to the nine groups, each group is further divided into more detailed categories. Medical coders and billers do not have to memorize groups and categories, but they should have a working knowledge of how to identify the right group and category for each item on the UB-04 claim form.

More About the Claim Form

It should be noted that the UB-04 form was previously known as Form CMS-1450. The form is utilized by long-term care facilities to bill Medicare and Medicaid for covered products, services, and procedures. UB-04 revenue codes are used only by eligible facilities on UB-04 claim forms. They are not utilized in any other way or in any other form.

Entities likely to utilize UB-04 claim form include, but are not limited to:

• Hospitals
• Hospice centers
• Skilled nursing facilities
• Rural healthcare clinics
• Specialized healthcare clinics

The types of services, procedures, and products the codes are used to document include things like:

• Medical procedures
• Laboratory and imaging services
• Prescription medications
• Surgical procedures
• Medical supplies and equipment
• Room and board

It is imperative that medical coders and billers use the appropriate revenue codes to ensure that UB-04 claims are processed quickly and properly. Improper codes increase the chances of claims being sent back for correction.

Tips for Using the Codes Correctly

Employing UB-04 revenue codes isn't necessarily any more or less complicated than utilizing other code sets. As such, there are some common tips for using the codes correctly. They begin with checking to see what information payers need when UB-04 claims are filed.

Coders and billers are also advised to:

• Double Check Form Fields – All form fields should be double checked prior to submission to ensure that all required information is entered and in the correct field.
• Double Check Patient Info – Patient information, including name and insurance data, should be double checked for accuracy prior to submission. It needs to be entered on UB-04 exactly as it appears on the patient's insurance card.
• Double Check Codes – In addition to the revenue codes, coders and billers will utilize CPT and ICD-10 codes. They should be double-checked for accuracy.

Only physical addresses should be used for service facilities and the National Provider Identifier (NPI) should be provided when needed. As long as the UB-04 revenue codes are used as intended, there shouldn't be any problem processing associated claims. UB-04 revenue codes are fundamental to medical billing, despite being somewhat obscure by comparison.