UB04 Revenue Code Code 0450: Emergency Room

Overview

Revenue Code 0450 (Emergency Room – General) is used on the UB-04 claim form to bill for general emergency room services provided to patients. This code falls under the 045X series, which covers emergency room services, with 0450 representing the general category for emergency department visits ^[1]. The UB-04 form is required for various provider types submitting paper claims to MassHealth, including acute inpatient hospitals, acute outpatient hospitals, chronic disease and rehabilitation hospitals, community health centers (for home health services only), home health agencies, hospice providers, psychiatric hospitals, and substance use disorder treatment facilities ^[2]. Up to 22 revenue codes and associated charges may be entered on each UB-04 claim form, and for outpatient claims, providers should bundle services to submit the claim on a single form ^[2]. The 045X series includes specific subcodes: 0451 for EMTALA screening, 0452 for ER services beyond EMTALA, 0456 for urgent care, and 0459 for other emergency room services ^[1]. Revenue Code 0450 is distinct from these subcodes and should only be used when billing for general emergency room services that do not fall under a more specific category.

When to Use

Revenue Code 0450 should be used when billing for general emergency room services provided in a hospital-based emergency department. This code is appropriate for emergency room visits that do not require a more specific subcode, such as 0451 (EMTALA screening) or 0452 (ER services beyond EMTALA) ^[1]. Providers must ensure they are using the correct revenue code based on the nature of the emergency service rendered. For example, if a patient presents to the emergency department and receives a medical screening examination required under the Emergency Medical Treatment and Labor Act (EMTALA), the appropriate code would be 0451, not 0450 ^[1]. Similarly, if the patient receives services beyond the EMTALA screening, such as diagnostic tests or treatment, code 0452 should be used ^[1]. Revenue Code 0450 is best reserved for general emergency room charges that do not fit into these specific subcategories. The UB-04 claim form is used by providers such as acute inpatient hospitals, acute outpatient hospitals, chronic disease and rehabilitation hospitals, psychiatric hospitals, and substance use disorder treatment facilities when submitting paper claims to MassHealth ^[2]. Providers should also note that for outpatient claims, services should be bundled to submit the claim on a single form, and up to 22 revenue codes and associated charges may be entered on each claim ^[2].

Step-by-Step Claim Example

Scenario: A patient presents to the emergency department of an acute outpatient hospital for a general emergency room visit. The patient receives evaluation and treatment for a minor injury, and the provider bills for the emergency room services using Revenue Code 0450.

Step 1: Complete the UB-04 Claim Form Header
Enter the provider's name, address, and National Provider Identifier (NPI) in the appropriate fields. Enter the patient's name, date of birth, and member ID number as required by MassHealth ^[2].

Step 2: Enter Revenue Code 0450 in Field 42
In the revenue code section of the UB-04 form, enter "0450" in the first revenue code line. This indicates that the service being billed is for general emergency room services ^[1].

Step 3: Enter the Service Date and Charge
In the corresponding service date field, enter the date of the emergency room visit. In the charge field, enter the total charge for the emergency room services provided, such as $500.00 for the evaluation and treatment ^[2].

Step 4: Enter Additional Revenue Codes if Needed
If the patient received additional services during the emergency room visit, such as radiology or laboratory tests, enter the appropriate revenue codes (e.g., 032X for radiology or 030X for laboratory) on subsequent lines. Up to 22 revenue codes and associated charges may be entered on each UB-04 claim form ^[2].

Step 5: Complete the Remaining Fields
Fill in all other required fields on the UB-04 form, including the patient's diagnosis codes, attending physician NPI, and any other necessary information. For outpatient claims, bundle services to submit the claim on a single form ^[2].

Step 6: Submit the Claim
Submit the completed UB-04 claim form to MassHealth according to the payer's submission guidelines. Note that MassHealth requires all claims to be submitted electronically unless the provider has received an approved electronic claim submission waiver ^[2].

Common Mistakes & Audit Red Flags

Using 0450 When a More Specific Code Applies
One of the most common mistakes is using Revenue Code 0450 for emergency room services that should be billed under a more specific subcode. For example, if the patient received only an EMTALA screening, the correct code is 0451, not 0450 ^[1]. Similarly, if the patient received services beyond the screening, code 0452 should be used ^[1]. Using the wrong revenue code can lead to claim denials or audits.

Billing Urgent Care Services Under 0450
Revenue Code 0456 is specifically designated for urgent care services, while 0450 is for general emergency room services ^[1]. Providers should ensure they are using the correct code based on the type of service provided. Billing urgent care services under 0450 may result in claim rejections or recoupment.

Exceeding the 22-Line Limit on Paper Claims
The UB-04 claim form allows up to 22 revenue codes and associated charges per claim ^[2]. For inpatient claims that exceed 22 lines, providers must submit an electronic claim instead of a paper claim ^[2]. Failing to follow this rule can result in claim rejection.

Incorrect Bundling of Outpatient Services
For outpatient claims, services must be bundled to submit the claim on a single form ^[2]. Providers who fail to bundle services appropriately may face claim denials or payment delays.

Submitting Paper Claims Without a Waiver
Massachusetts requires all claims to be submitted electronically unless the provider has received an approved electronic claim submission waiver ^[2]. Submitting paper claims without a waiver is a common audit red flag and can lead to claim rejection.

Related Codes/Fields

Code/Field	Description	Source
0451	EMTALA screening – Used for medical screening examinations required under EMTALA	[1]
0452	ER beyond EMTALA – Used for emergency room services provided beyond the initial screening	[1]
0456	Urgent care – Used for urgent care services provided in an emergency room setting	[1]
0459	Other emergency room services – Used for emergency room services not covered by other subcodes	[1]
0516	Urgent care clinic – Used for urgent care services provided in a clinic setting	[1]
Field 42	Revenue code field on the UB-04 claim form where codes like 0450 are entered	[2]
Field 43	Revenue description field on the UB-04 claim form	[2]
Field 44	HCPCS/Rate code field on the UB-04 claim form	[2]
Field 45	Service date field on the UB-04 claim form	[2]
Field 46	Units of service field on the UB-04 claim form	[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