Overview
Field 42 (Revenue Code) is a required field on the UB-04 claim form for both inpatient and outpatient services [FIELD: Revenue Code (Box 42)]. This field identifies the specific accommodation, ancillary service, or billing department where a service was provided within the hospital or facility setting [1]. For acute inpatient hospitals (AIHs), these codes must align with MassHealth-covered services as defined in the provider manual [2].
The codes are typically four-digit numeric values that categorize hospital charges [2]. For example, code 0001 is used to represent the "Total Charge" on the claim, while codes in the 011x through 015x series represent various room and board classifications such as private, semi-private, or ward accommodations [2]. Other series, such as 025x for Pharmacy or 027x for Medical/Surgical Supplies, identify specific ancillary categories [2]. To ensure accurate billing, providers must refer to the current edition of the Uniform Billing Editor for appropriate mappings between revenue codes and Healthcare Common Procedure Coding System (HCPCS) codes [2].
When to Use
Revenue codes must be used by acute inpatient and outpatient hospitals when submitting paper claims to MassHealth [3]. Inpatient claims require these codes to detail room and board stays, such as Intensive Care (020x) or Coronary Care (021x), as well as incremental nursing charges (023x) [2].
For inpatient billing, revenue codes are used to distinguish between different levels of care, such as Newborn Level I through Level IV (0171–0174) or various psychiatric and detoxification settings [2]. Additionally, they are used to report specific charges like technical support (0222), UR service charges (0223), or medically necessary late discharges (0224) [2]. Providers must also use specific revenue codes for pharmacy services (025x/063x) and IV therapy (026x) to ensure the nature of the drug or delivery method is correctly identified for reimbursement [2].
Step-by-Step Claim Example
When completing Field 42 on the UB-04 claim form, follow these steps based on MassHealth requirements:
- Identify the Service Category: Determine the correct four-digit code for the service provided. For a standard medical/surgical stay in a semi-private room, select code 0121 [2].
- Enter Ancillary Services: If the patient received IV therapy with an infusion pump, enter code 0261 on a subsequent line [2].
- Report Supplies: If the patient required a prosthetic or orthotic device, enter code 0274 [2].
- List Pharmacy Charges: For non-generic drugs administered during the stay, use code 0252 [2].
- Finalize with Total: On the final line of the service section in Field 42, enter code 0001 to represent the "Total Charge" for all listed items [2].
- Verify Mapping: Check the Uniform Billing Editor to ensure the selected revenue codes correctly map to any required HCPCS codes for the specific service [2].
Common Mistakes & Audit Red Flags
- Incorrect Code Mapping: Using a revenue code that does not properly map to the corresponding HCPCS code according to the Uniform Billing Editor is a frequent cause of claim rejection [2].
- Missing Total Charge Line: Failing to include revenue code 0001 at the end of the itemized list to signify the total charges is a technical error [2].
- Using Non-Covered Codes: Submitting codes not listed in the MassHealth Appendix G, such as unauthorized "Other" codes (e.g., 0119, 0129) without proper justification, may trigger an audit or denial [2].
- Inaccurate Level of Care: Reporting a higher level of nursery care (e.g., Level IV - 0174) than what was medically necessary or documented in the patient record is a significant audit red flag [2].
Related Codes/Fields
| Field/Code | Description | Source |
|---|---|---|
| 0001 | Revenue code for "Total Charge" | [2] |
| 011x - 015x | Room and Board classifications (Private, Semi-private, Ward) | [2] |
| 025x / 063x | Pharmacy and Pharmacy extension codes | [2] |
| 027x / 062x | Medical/Surgical Supplies and Devices and extensions | [2] |
| HCPCS | Healthcare Common Procedure Coding System (must map to Revenue Codes) | [2] |
| POSC | Provider Online Service Center for electronic submissions | [3] |
References
[1] Appendix G — https://www.mass.gov/doc/appendix-g-revenue-codes/download
[2] Appendix G — https://www.mass.gov/doc/appendix-g-revenue-codes/
[3] Billing Guide for the UB-04 — https://www.mass.gov/doc/ub-04-billing-guide-0/download
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Last Updated: 2026-05-29
Sources: CMS Pub. 100-04 Chapter 25, NUBC Official UB-04 Manual, Medicare Contractor Bulletins (Noridian, Palmetto, CGS)