UB04 Reference

UB04 Field 42: Revenue Code

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UB04 Fields / field-42

Overview

Field 42 (Revenue Code) is a four-digit numeric code that identifies the specific accommodation, ancillary service, or billing department where a patient received care. Located in the central service section of the UB-04 (CMS-1450) claim form, this field is the primary mechanism for categorizing hospital costs for reimbursement. Every line item on an institutional claim must begin with a revenue code to tell the payer "where" the service occurred, which in turn determines the payment methodology—such as Diagnosis Related Groups (DRG) for inpatients or Ambulatory Payment Classifications (APC) for outpatients.

The National Uniform Billing Committee (NUBC) maintains the official list of revenue codes, which are required for all institutional providers, including hospitals, skilled nursing facilities (SNFs), and home health agencies CMS Pub. 100-04 Chapter 25. Revenue codes must be listed in ascending numeric order on the claim, with the exception of the final line, which must always be 0001 to represent the total charges.

When to Use This Field

Field 42 is mandatory for every institutional claim. It bridges the gap between the clinical procedure and the facility's financial structure. For inpatient stays, revenue codes like 0120 (Semi-Private Room) capture the daily room and board rate. For outpatient encounters, revenue codes like 0450 (Emergency Room) or 0360 (Operating Room) categorize the facility's overhead and resource consumption.

Example 1: Inpatient Surgical Stay A patient is admitted for a hip replacement. The biller must use 0120 for the room charges, 0360 for the time spent in the operating room, 0370 for anesthesia services, and 0270 for the medical supplies used during the procedure. Each code corresponds to a specific cost center in the hospital's chargemaster.

Example 2: Outpatient Observation A patient presents to the ER with chest pain and is moved to observation status. The biller uses 0450 for the initial ER evaluation and 0762 for the observation room hours. Medicare requires specific revenue code and HCPCS combinations to trigger "Comprehensive APC" payments Medicare Claims Processing Manual.

Step-by-Step Claim Example

Patient Scenario: A 68-year-old Medicare beneficiary is admitted to an acute care hospital for three days due to pneumonia. During the stay, the patient receives intravenous antibiotics, daily chest X-rays, and laboratory blood work.

  1. Field 42 (Line 1): Enter 0120 (Room & Board - Semi-Private).
  2. Field 46 (Units): Enter 3 (representing the three-day stay).
  3. Field 42 (Line 2): Enter 0250 (Pharmacy - General) for the oral medications.
  4. Field 42 (Line 3): Enter 0260 (IV Therapy) for the administration of IV antibiotics.
  5. Field 42 (Line 4): Enter 0300 (Laboratory - General) for the blood tests.
  6. Field 42 (Line 5): Enter 0320 (Radiology - Diagnostic) for the chest X-rays.
  7. Field 42 (Final Line): Enter 0001 (Total Charge) to sum all previous lines.

Payer Response: The Medicare Administrative Contractor (MAC) validates that the revenue codes match the Type of Bill (Field 4) and the HCPCS codes (Field 44) where applicable. If the biller used 0110 (Private Room) without a medical necessity certification, the payer may downcode the reimbursement to the semi-private rate (0120) or deny the line item entirely.

Common Mistakes & Audit Red Flags

  • Revenue/HCPCS Mismatches: Payers frequently deny claims where the revenue code in Field 42 is incompatible with the CPT/HCPCS code in Field 44. For example, billing a surgical CPT code under revenue code 0510 (Clinic) instead of 0360 (Operating Room) will trigger a "service/location" mismatch denial.
  • Invalid "000" General Codes: While "0X00" codes (like 0300 or 0360) are valid, some payers require the fourth digit to be more specific (e.g., 0301 for Chemistry) to provide granular data. Using general codes for high-cost pharmacy items instead of 0636 (Drugs Requiring Detailed Coding) often leads to line-item denials for lack of specificity.
  • Missing Total Charge Line: Failing to include revenue code 0001 as the final entry is a common technical error that causes immediate clearinghouse rejection.

Related Codes & Fields

Primary Fields

Revenue Codes

References

  1. CMS Pub. 100-04 Chapter 25
  2. Medicare Claims Processing Manual

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FormJuicer Data Insights

This guide was developed by the FormJuicer Billing Research Team using official CMS and NUBC guidelines, combined with patterns observed from processing thousands of real UB-04 documents through our system.

Last Updated: 2026-05-01

Sources: CMS Pub. 100-04 Chapter 25, NUBC Official UB-04 Manual, Medicare Contractor Bulletins (Noridian, Palmetto, CGS)