UB04/CMS1450 Revenue Codes - Group 01
- 0100 All-Inclusive Room and Board Plus Ancillary UB04 Revenue Code
- 0101 All-Inclusive Room and Board UB04 Revenue Code
- 010X All Inclusive Rate UB04 Revenue Code
- 0110 General Classification UB04 Revenue Code
- 0111 Medical/Surgical/Gyn UB04 Revenue Code
- 0112 OB UB04 Revenue Code
- 0113 Pediatric UB04 Revenue Code
- 0114 Psychiatric UB04 Revenue Code
- 0115 Hospice UB04 Revenue Code
- 0116 Detoxification UB04 Revenue Code
- 0117 Oncology UB04 Revenue Code
- 0118 Rehabilitation UB04 Revenue Code
- 0119 Other UB04 Revenue Code
- 011X Room & Board - Private (Medical or General) UB04 Revenue Code
- 0120 General Classification UB04 Revenue Code
- 0121 Medical/Surgical/Gyn UB04 Revenue Code
- 0122 OB UB04 Revenue Code
- 0123 Pediatric UB04 Revenue Code
- 0124 Psychiatric UB04 Revenue Code
- 0125 Hospice UB04 Revenue Code
- 0126 Detoxification UB04 Revenue Code
- 0127 Oncology UB04 Revenue Code
- 0128 Rehabilitation UB04 Revenue Code
- 0129 Other UB04 Revenue Code
- 012X Room & Board - Semi-private Two Beds (Medical or General) UB04 Revenue Code
- 0130 General Classification UB04 Revenue Code
- 0131 Medical/Surgical/Gyn UB04 Revenue Code
- 0132 OB UB04 Revenue Code
- 0133 Pediatric UB04 Revenue Code
- 0134 Psychiatric UB04 Revenue Code
- 0135 Hospice UB04 Revenue Code
- 0136 Detoxification UB04 Revenue Code
- 0137 Oncology UB04 Revenue Code
- 0138 Rehabilitation UB04 Revenue Code
- 0139 Other UB04 Revenue Code
- 013X Semi-private - three and Four Beds (Medical or General) UB04 Revenue Code
- 0140 General Classification UB04 Revenue Code
- 0141 Medical/Surgical/Gyn UB04 Revenue Code
- 0142 OB UB04 Revenue Code
- 0143 Pediatric UB04 Revenue Code
- 0144 Psychiatric UB04 Revenue Code
- 0145 Hospice UB04 Revenue Code
- 0146 Detoxification UB04 Revenue Code
- 0147 Oncology UB04 Revenue Code
- 0148 Rehabilitation UB04 Revenue Code
- 0149 Other UB04 Revenue Code
- 014X Private - (Deluxe) (Medical or General) UB04 Revenue Code
- 0150 General Classification UB04 Revenue Code
- 0151 Medical/Surgical/Gyn UB04 Revenue Code
- 0152 OB UB04 Revenue Code
- 0153 OB/ WARD UB04 Revenue Code
- 0154 Psychiatric UB04 Revenue Code
- 0155 Hospice UB04 Revenue Code
- 0156 Detoxification UB04 Revenue Code
- 0157 Oncology UB04 Revenue Code
- 0158 Rehabilitation UB04 Revenue Code
- 0159 Other UB04 Revenue Code
- 015X Room & Board - Ward (Medical or General) UB04 Revenue Code
- 0160 General Classification UB04 Revenue Code
- 0161 Hospital at home UB04 Revenue Code
- 0164 Sterile Environment UB04 Revenue Code
- 0167 Self Care UB04 Revenue Code
- 0169 Other UB04 Revenue Code
- 016X Other Room & Board (Medical or General) UB04 Revenue Code
- 0170 Classification UB04 Revenue Code
- 0171 Newborn - Level I UB04 Revenue Code
- 0172 Newborn - Level II UB04 Revenue Code
- 0173 Newborn - Level III UB04 Revenue Code
- 0174 Newborn - Level IV UB04 Revenue Code
- 0179 Other UB04 Revenue Code
- 017X Nursery UB04 Revenue Code
- 0180 General Classification UB04 Revenue Code
- 0181 Leave of Absence: Reserved UB04 Revenue Code
- 0182 Patient Convenience -Charges billable UB04 Revenue Code
- 0183 LOA/PT CONV CHGS BILLABLE UB04 Revenue Code
- 0184 Leave of Absence: RESERVED UB04 Revenue Code
- 0185 Nursing Home (For Hospitalization) UB04 Revenue Code
- 0189 Other Leave of Absence UB04 Revenue Code
- 018X Leave of Absence UB04 Revenue Code
- 0190 Classification UB04 Revenue Code
- 0191 Sub-acute Care - Level I UB04 Revenue Code
- 0192 Sub-acute Care - Level II UB04 Revenue Code
- 0193 Sub-acute Care - Level III UB04 Revenue Code
- 0194 Sub-acute Care - Level IV UB04 Revenue Code
- 0199 Other Sub-acute Care UB04 Revenue Code
- 019X Sub-acute Care UB04 Revenue Code
Back to UB04/CMS1450 Revenue Codes Groups List
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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