Outpatient Claims – Revenue Codes

Outpatient claims can now be submitted with valid National Uniform Billing Code (NUBC) revenue codes.  Revenue codes have not been required for outpatient billing in the past. Beginning with dates of service on July 1, 2010 and forward, the Medi-Cal system has been remediated so that outpatient claims can accept revenue codes.  As a result:

• EAPC claims must include the required revenue code in the Revenue Code field (Box 42) and the HCPCS code immediately followed by the appropriate modifier in the HCPCS/Rate field (Box  44). Claims submitted without all three will be denied.  At this time, only EAPC claims require a revenue code.
• Providers should not enter information in the revenue code field unless it is a valid NUBC revenue code.  Revenue codes are listed in the NUBC Official UB-04 Data Specification Manual accessed through the NUBC Web site at https://www.nubc.org <https://www.nubc.org/>
• Providers should not enter procedure codes in the revenue code field (box 42).
• At a future date, claims will deny for invalid revenue codes, therefore provider billing systems should be updated now to accept NUBC revenue codes.
• Providers should continue to use the ‘0001’ code for the Totals line on the claim form as applicable.
• Remittance Advice Details (RADs) will be updated in September 2010 to include revenue codes for outpatient claims.
• Additionally, the Supplemental Claim Payment Information (SCPI) data for record layout will be updated, effective June 25, 2010, to accommodate revenue codes and modifiers to outpatient records.