What Is Revenue?

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What Is Revenue?

The revenue code uniquely identifies the service rendered to the patient on an inpatient hospital, outpatient hospital, or hospice claim.

It is a four-digit code and the last position determines its subcategory. For example: 010X thru 0210X are revenue codes for accommodations. 010X represents the All Inclusive Rate category. It subcategories are:

0 - All-Inclusive Room and Board plus Ancillary
1 - All-Inclusive Room and Board

Therefore, revenue codes in the 010X category are: 0100 and 0101.

The revenue codes on a UB-92 or UB-04 claim form is entered in position 42 on the form. Position 42 is called Form Locator 42 or FL 42.

A provider places the revenue code on the claim to identify specific accommodations and/or ancillary charges. For each revenue code entered, it is the sum of charges billed against the revenue code.

The provider is requested to list the revenue codes on the claim in ascending order. This ensures that one or more revenue codes are not repeated. To limit the number of line items on the claim, the revenue codes should be summed unless detail is required.

For example, Renal Dialysis Centers would bill the following revenue center codes at the detailed level:

0304 - renal and dialysis/laboratory
0636 - hemophilia blood clotting factors
0800s thru 0850s - ESRD services

In some cases, the revenue code may require a procedure code also be present on the claim to ensure that reasonable charges are paid. For example: a hospice revenue code of 0657 requires a physician procedure code on the claim.

There is a limited volume of these codes and they change frequently.

There is no batch process to load revenue codes into ND MMIS. They are only added via the North Dakota MMIS Web Portal using Revenue in the Code Maintenance function of Rules Management. Before adding or editing a revenue code, State approval is required. Any retroactive updates issue a warning message. Once a retroactive change is confirmed and applied, ND MMIS triggers a mass adjustment process to reprocess affected claims.