Revenue Codes 0420: 2025 Physical Therapy Billing
In 2025, revenue code 0420 continues to be the standard UB-04 code for general physical therapy services rendered in hospital or facility settings. This guide explains how to report 0420 correctly on claims, pair it with the proper HCPCS codes and modifiers, navigate recent payer policy updates, and avoid common billing pitfalls. Whether you bill inpatient or outpatient services, you’ll find actionable tips and links to CMS resources, commercial insurer rules, and internal guides to enhance your workflow.
What Is Revenue Code 0420?
Revenue code 0420 is part of the 042X series designated for physical therapy on the UB-04/CMS-1450 claim form. Specifically, 0420 represents the “General Classification” for facility-based physical therapy services. It tells payers that charges are related to department-level PT services rather than a specific visit or evaluation. Noridian Medicare – Revenue Codes :contentReference[oaicite:0]{index=0}
Reporting 0420 on UB-04
Form Locator 42: Revenue Code
On the UB-04 form, enter 0420 in FL 42 (Revenue Code) for each line item that reflects physical therapy charges. Then, report units in FL 46 and total charges in FL 47. Make sure that each line’s dates of service align with the therapy provided. CMS Claims Processing Manual, Ch 5, Sec 100.12 :contentReference[oaicite:1]{index=1}
Common FL 46/FL 47 Errors
Frequently, billers leave FL 46 (Service Units) blank or miscount 15-minute increments. Units must reflect actual therapy minutes. Additionally, mismatches between units and charges trigger denials. To reduce errors, adopt consistent time-tracking protocols and audit claim samples monthly. PCH Health – Revenue Code Basics :contentReference[oaicite:2]{index=2}
Pairing 0420 with HCPCS & Modifiers
Revenue code 0420 must be paired with discipline-specific HCPCS and the correct modifier. For example, physical therapy evaluation HCPCS codes (e.g., 97161–97164) always carry modifier GP. Likewise, timed PT services (e.g., 97110) use GP. This ensures Medicare and MACs process claims under the correct therapy discipline. CMS Claims Processing Manual, Ch 5 :contentReference[oaicite:3]{index=3}
2025 Payer Policy Highlights
UnitedHealthcare & Anthem
UnitedHealthcare requires a PT evaluation to precede timed therapeutic procedures when billing 0420. Anthem imposes a 25-visit per calendar year limit for outpatient PT unless medically necessary documentation is submitted. Always verify Medical Necessity Guidelines on payer portals before claim submission. Horizon Blue – Revenue Codes Requiring HCPCS :contentReference[oaicite:4]{index=4}
Medicare Administrative Contractors (MACs)
In 2025, MACs continue to enforce modifier GP on 042X lines. Some MACs require pre-certification for extended PT plans beyond 30 calendar days. Check your MAC’s local coverage determinations (LCDs) and billing articles for updates. CMS Medicare Coverage Database – A57311 :contentReference[oaicite:5]{index=5}
Best Practices for Accurate Billing
- Document thoroughly: Record therapy goals, modalities, and patient response in clinical notes.
- Use consistent time tracking: Round to the nearest 15-minute increment and reconcile daily.
- Audit claims: Perform weekly audits to catch FL 46/FL 47 and modifier mismatches early.
- Stay current: Subscribe to CMS and AAPC newsletters for policy alerts.
Frequently Asked Questions
Can I report 0420 for group therapy sessions?
No. Group therapy requires revenue code 0423. Use 0420 only for general department PT charges not tied to visit count. Noridian Medicare – Revenue Codes :contentReference[oaicite:6]{index=6}
Does inpatient PT use the same code?
Yes. Both inpatient and outpatient hospital PT services use revenue code 0420 for general classifications. However, verify any bundled payment rules under IPPS. BellMedEx – What Is a Revenue Code? :contentReference[oaicite:7]{index=7}
Learn More
For additional guidance, explore our UB-04 coding guide, review our physical therapy billing tips, or check out our overview of revenue codes.
References
- Noridian Medicare, “Revenue Codes,” accessed May 2025, link. :contentReference[oaicite:8]{index=8}
- CMS Claims Processing Manual, Chapter 5, Sec 100.12, accessed May 2025, link. :contentReference[oaicite:9]{index=9}
- Horizon Blue, “Revenue Codes Requiring HCPCS Codes,” accessed May 2025, link. :contentReference[oaicite:10]{index=10}
- PCH Health, “Revenue Code Basics,” accessed May 2025, link. :contentReference[oaicite:11]{index=11}
- CMS Medicare Coverage Database, Article A57311, accessed May 2025, link. :contentReference[oaicite:12]{index=12}
- BellMedEx, “What Is a Revenue Code in Medical Billing?” accessed May 2025, link. :contentReference[oaicite:13]{index=13}
- SimiTree Health, “Overview of Home Health Billing Codes,” accessed May 2025, link. :contentReference[oaicite:14]{index=14}