UB04/CMS1450 Revenue Codes - Group 04
- 0400 General Classification UB04 Revenue Code
- 0401 Diagnostic Mammography UB04 Revenue Code
- 0402 Ultrasound UB04 Revenue Code
- 0403 Screening Mammography UB04 Revenue Code
- 0404 Positron Emission Tomography UB04 Revenue Code
- 0409 Other Imaging Services UB04 Revenue Code
- 040X Other Imaging Services UB04 Revenue Code
- 0410 General Classification UB04 Revenue Code
- 0412 Inhalation Services UB04 Revenue Code
- 0413 Hyperbaric Oxygen Therapy UB04 Revenue Code
- 0419 Other Respiratory Services UB04 Revenue Code
- 041X Respiratory Services UB04 Revenue Code
- 0420 General Classification UB04 Revenue Code
- 0421 Visit Charge UB04 Revenue Code
- 0422 Hourly Charge UB04 Revenue Code
- 0423 Group Rate UB04 Revenue Code
- 0424 Evaluation or Re-evaluation UB04 Revenue Code
- 0429 Other Physical Therapy UB04 Revenue Code
- 042X Physical Therapy UB04 Revenue Code
- 0430 General Classification UB04 Revenue Code
- 0431 Visit Charge UB04 Revenue Code
- 0432 Hourly Charge UB04 Revenue Code
- 0433 Group Rate UB04 Revenue Code
- 0434 Evaluation or Re-evaluation UB04 Revenue Code
- 0439 Other Occupational Therapy (may include restorative therapy) UB04 Revenue Code
- 043X Occupational Therapy UB04 Revenue Code
- 0440 General Classification UB04 Revenue Code
- 0441 Visit Charge UB04 Revenue Code
- 0442 Hourly Charge UB04 Revenue Code
- 0443 Group Rate UB04 Revenue Code
- 0444 Evaluation or Re-evaluation UB04 Revenue Code
- 0449 Other Speech-Language Pathology UB04 Revenue Code
- 044X Speech Therapy UB04 Revenue Code
- 0450 General Classification UB04 Revenue Code
- 0451 EMTALA Emergency Medical screening services UB04 Revenue Code
- 0452 ER Beyond EMTALA Screening UB04 Revenue Code
- 0456 Urgent Care UB04 Revenue Code
- 0459 Other Emergency Room UB04 Revenue Code
- 045X Emergency Room UB04 Revenue Code
- 0460 General Classification UB04 Revenue Code
- 0469 Other Pulmonary Function UB04 Revenue Code
- 046X Pulmonary Function UB04 Revenue Code
- 0470 General Classification UB04 Revenue Code
- 0471 Diagnostic UB04 Revenue Code
- 0472 Treatment UB04 Revenue Code
- 0479 AUDIOLOGY/RX UB04 Revenue Code
- 047X Audiology UB04 Revenue Code
- 0480 General Classification UB04 Revenue Code
- 0481 Cardiac Cath Lab UB04 Revenue Code
- 0482 Stress Test UB04 Revenue Code
- 0483 Echo cardiology UB04 Revenue Code
- 0489 Other Cardiology UB04 Revenue Code
- 048X Cardiology UB04 Revenue Code
- 0490 General Classification UB04 Revenue Code
- 0499 Other Ambulatory Surgical Care UB04 Revenue Code
- 049X Ambulatory Surgical Care 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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