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Tip: Understand revenue codes

Ambulatory Surgery Reimbursement Update, April 8, 2008

Revenue codes are three-digit codes that affect reimbursement and represent the services provided by the ASC facility for a payer. Note that you can't report revenue codes on a CMS-1500 form, but you can report them on a UB-04. So for those payers to whom you file on UB-04 claim forms, you can (unless prohibited by your contract with the payer) break out your charges and bill for some ancillary services, like supplies.

For each line item charge listed on the claim, there must be an associated revenue code listed. However, not all charges on the claim will have an associated CPT code when you bill in this manner.

List charges for ancillary services (such as supplies) with a revenue code and a word description only.

For every CPT code listed on the UB-04 claim form, the CPT code for procedure(s) performed should be listed with a 490 revenue code for ASC surgical procedures.

Implants are listed with the 278 revenue code or with 276 for intraocular lenses (IOL) (used in cataract procedures). When revenue codes are listed on claim forms, they are listed with a leading zero, making them four digits.

There are hundreds of revenue codes, many of which are not applicable for ASCs, however, the ones most commonly used are as follows:

  • Code 250 for pharmacy services
  • Code 270 for medical/surgical supplies
  • Code 272 for sterile supplies
  • Code 274 for prosthetic/orthotic devices
  • Code 276 for IOL implants (cataracts)
  • Code 279 for supplies
  • Code 278 for other implants
  • Code 320 for x-rays (rluoroscopy)
  • Code 370 for general anesthesia (bill time as units)
  • Code 379 for other anesthesia (bill time as units)
  • Code 490 for ASC surgical procedures
  • Code 710 for recovery room services (PACU) (bill time as units)

This tip is brought to you by Ellis Medical Consulting, Inc.