UB04 Revenue Code Code 0420: Physical Therapy

Overview

Revenue Code 0420 is used on the UB-04 claim form to bill for Physical Therapy – General services. This code falls under the 042X series, which covers all physical therapy services provided in inpatient or outpatient settings. According to the Noridian Revenue Codes list, the 042X category includes: 0420 General, 0421 Visit charge, 0422 Hourly charge, 0423 Group rate, 0424 Evaluation, and 0429 Other. ^[1]

When to Use

Providers should use 0420 for the initial or general billing of physical therapy services when the specific type of service (e.g., evaluation vs. treatment session) is not separately tracked or when the service does not match the definitions of 0421 (Visit charge), 0422 (Hourly charge), 0423 (Group rate), or 0424 (Evaluation). ^[1] This code is commonly used by hospital outpatient departments, rehabilitation hospitals, skilled nursing facilities, home health agencies, and outpatient physical therapy clinics.

Step-by-Step Claim Example

Scenario: A patient receives 45 minutes of general physical therapy (therapeutic exercises and manual therapy) in a hospital outpatient department. The provider bills using Revenue Code 0420.

Step 1: Complete the UB-04 claim form header with patient and provider information, including the patient's name, date of birth, health insurance ID number, and the provider's National Provider Identifier (NPI) and Tax ID number.

Step 2: In Form Locator 42 (Revenue Code), enter 0420 for the physical therapy service. ^[1]

Step 3: In Form Locator 43 (Revenue Description), enter a brief description such as "Physical Therapy – General" or "PT General."

Step 4: In Form Locator 44 (HCPCS/Rate), enter the appropriate HCPCS code for the service (e.g., 97110 for therapeutic exercises, 97140 for manual therapy). If multiple HCPCS codes apply, use separate lines with the same 0420 revenue code.

Step 5: In Form Locator 45 (Service Date), enter the date of service (e.g., 01/15/2024).

Step 6: In Form Locator 46 (Units of Service), enter the number of units (e.g., 3 units for 45 minutes of therapeutic exercises).

Step 7: In Form Locator 47 (Total Charges), enter the total charge for the service (e.g., $150.00).

Step 8: Repeat steps 2-7 for any additional physical therapy services provided on the same date, using the appropriate subcategory codes (0421, 0422, etc.) if applicable.

Step 9: Complete remaining form locators (e.g., patient control number, medical record number, diagnosis codes in FL 67, and payer information in FL 50-65).

Step 10: Submit the claim electronically (as required by MassHealth unless a waiver is obtained) or on paper if an approved waiver exists. ^[2]

Common Mistakes & Audit Red Flags

1. Using 0420 when a more specific code is required: Avoid using 0420 (General) when the service qualifies for 0424 (Evaluation) or 0422 (Hourly charge). Payers may deny or downcode claims that lack specificity. ^[1]

2. Mixing physical therapy with other therapy types on the same line: Do not combine physical therapy (042X) with occupational therapy (043X) or speech therapy (044X) on the same revenue code line. Each therapy type requires its own revenue code. ^[1]

3. Incorrect units of service: Physical therapy services are often billed in 15-minute units. Billing incorrect units (e.g., billing 1 unit for 45 minutes) can trigger audits and recoupment.

4. Missing or incorrect HCPCS codes: Revenue Code 0420 requires a corresponding HCPCS code (e.g., 97110, 97140, 97112) to describe the specific service. Omitting or using incorrect HCPCS codes may result in claim denial.

5. Exceeding 22 revenue code lines on paper claims: MassHealth allows up to 22 revenue codes per UB-04 form. For inpatient claims exceeding 22 lines, submit electronically. For outpatient claims, bundle services. ^[2]

6. Submitting paper claims without an approved waiver: MassHealth requires electronic submission for all claims unless the provider has an approved electronic claim submission waiver. ^[2]

Related Codes/Fields

Code/Field	Description	Relationship to 0420
0421	Physical Therapy – Visit charge	Use when billing per visit rather than general service
0422	Physical Therapy – Hourly charge	Use when billing by the hour
0423	Physical Therapy – Group rate	Use for group therapy sessions
0424	Physical Therapy – Evaluation	Use for initial or periodic evaluations
0429	Physical Therapy – Other	Use for services not fitting other subcategories
0430	Occupational Therapy – General	Related therapy type, but separate revenue code
0440	Speech Therapy – General	Related therapy type, but separate revenue code
FL 44	HCPCS/Rate	Required to specify the exact service provided
FL 46	Units of Service	Must reflect correct units (typically 15-minute increments)
FL 47	Total Charges	Must match the sum of charges for all services billed

^{[1] [2]}

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References

[1] Noridian Revenue Codes — https://med.noridianmedicare.com/web/jea/topics/claim-submission/revenue-codes

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download