UB04 Revenue Code Code 0170: Nursery

Overview

Revenue code 0170 is a specific billing classification used by acute inpatient hospitals (AIHs) to identify general nursery services ^[1]. Within the Uniform Billing (UB-04) framework, this code falls under the broader 017x category, which is designated for Nursery room and board charges ^[2]. Specifically, 0170 represents the "General Classification" for nursery services, distinguishing it from more specialized levels of neonatal care such as Level I through Level IV newborn care ^[2].

According to the MassHealth Provider Manual, this code is part of a standardized set of revenue codes that must be used when billing for MassHealth-covered acute inpatient hospital services ^[2]. The use of revenue code 0170 allows facilities to report the routine room and board costs associated with the care of infants in a nursery setting ^[2]. For accurate billing, providers are instructed to refer to the current edition of the Uniform Billing Editor to determine the appropriate mappings between revenue codes and Healthcare Common Procedure Coding System (HCPCS) codes ^[2]. This code is essential for the administrative and financial processing of inpatient claims for pediatric and neonatal populations within participating facilities ^[2].

When to Use

Revenue code 0170 should be utilized when an acute inpatient hospital provides general nursery room and board services to a member ^[2]. It is specifically intended for "General Classification" nursery care ^[2]. Providers should select this code when the level of care provided does not meet the specific criteria for more intensive newborn levels, such as Newborn – Level I (0171), Level II (0172), Level III (0173), or Level IV (0174) ^[2].

This code is applicable for use by several types of facilities that submit claims via the UB-04 form, most notably acute inpatient hospitals ^[3]. It is used to capture the daily subsistence and routine nursing care costs for infants who do not require specialized intensive care or intermediate ICU services, which would otherwise be billed under the 020x (Intensive Care) or 021x (Coronary Care) series ^[2]. Additionally, if there are incremental nursing charges specifically for the nursery that are not covered by the base room and board rate, providers may need to look at the 023x series, specifically 0231 for Nursery incremental charges ^[2]. The code is entered in Field 42 of the UB-04 claim form to categorize the associated charges for the payer ^[3].

Step-by-Step Claim Example

To submit a claim including revenue code 0170, follow these steps based on the MassHealth billing requirements:

1. Identify the Service: Confirm that the service provided was general nursery room and board for an inpatient infant stay ^[2].
2. Access the UB-04 Form: Use the standard UB-04 paper claim form (or the Direct Data Entry system on the POSC) if you have an approved electronic claim submission waiver ^[3].
3. Complete Member Information: Ensure a separate claim form is completed for each individual member receiving services ^[3].
4. Enter Revenue Code in Field 42: In the "Revenue Code" column (Field 42), enter the four-digit code "0170" ^[2].
5. Enter Description and Charges: Provide the description "Nursery - General Classification" and enter the associated total charges for that line item ^[2].
6. Verify Mappings: Check the current Uniform Billing Editor to ensure the 0170 revenue code is correctly mapped to any required HCPCS codes if applicable for the specific hospital contract ^[2].
7. Submit Claim: Submit the completed form to MassHealth via the Provider Online Service Center (POSC) or via mail if a paper waiver is on file ^[3].

Common Mistakes & Audit Red Flags

• Incorrect Level of Care: A common error is using the general classification code 0170 when the infant's clinical status actually requires a higher level of care, such as Newborn Level III (0173) or Level IV (0174) ^[2]. Conversely, billing a higher level for a routine nursery stay is a significant audit red flag.
• Inappropriate Provider Type: Using 0170 for services provided in a non-acute setting where nursery codes are not authorized in the provider manual ^[3].
• Mapping Errors: Failing to refer to the Uniform Billing Editor for correct Revenue-HCPCS mappings can lead to claim denials or incorrect reimbursement ^[2].
• Paper Submission Without Waiver: Submitting a paper UB-04 claim without an approved electronic claim submission waiver from MassHealth is a violation of the all-electronic claims submission policy effective since 2012 ^[3].

Related Codes/Fields

Code/Field	Description	Source
0171	Newborn – Level I	[2]
0172	Newborn – Level II	[2]
0173	Newborn – Level III	[2]
0174	Newborn – Level IV	[2]
0179	Other Nursery	[2]
0231	Incremental Nursing Charge - Nursery	[2]
Field 42	Revenue Code Field on UB-04	[3]
0001	Total Charge	[2]

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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