What is a Revenue Code?
It is a three- or four-digit number that identifies the specific service area where the patient received treatment. These codes are used by hospitals and skilled nursing facilities to group services on a billing claim.
Revenue codes are essential in claims processing. They help insurance payers in understanding the nature of the service and whether it aligns with the patient’s benefits and coverage.
Each revenue code must correspond to a procedure or service, often paired with a CPT or HCPCS code.
Common Revenue Code Examples
- 0450 – Emergency Room (General)
- 0250 – Pharmacy (General)
- 0360 – Operating Room Services (General)
- 0420 – Physical Therapy (General)
- 0270 – Medical/Surgical Supplies (General)
These codes often include subcategories to reflect more specific service details (e.g., 0456 for urgent care within the ER).
How are Revenue Codes Used in Billing?
Revenue codes are reported on institutional claims and:
- Indicate the department or cost center associated with the provided service.
- Help determine reimbursement when linked with specific CPT or HCPCS codes.
- Are essential for Medicare and Medicaid billing compliance.
- Assist in categorizing charges correctly for the patient’s bill and insurer review.
Incorrect or missing revenue codes can lead to claim denials or payment delays. So accuracy is crucial in medical billing.
Revenue Codes vs. CPT/HCPCS Codes
While revenue codes indicate where or what type of service was provided, CPT/HCPCS codes describe what the actual procedure or service was. For a claim to be reimbursed correctly:
- The revenue code should match the CPT/HCPCS code.
- For example, Revenue Code 0450 (Emergency Room) might be paired with CPT code 99284 (emergency department visit of moderate complexity).