As medical billing professionals move into 2025, understanding value code 82 is essential. This article explains the latest Medicare co‑insurance day reporting rules, payer guidance, and practical tips to ensure clean claims and reduce denials.
Introduction to value code 82
In Medicare Part A hospital billing, value code 82 captures the number of Medicare co‑insurance days claimed during the inpatient service period. It pairs with value codes 80 (covered days) and 81 (non‑covered days) for utilization reporting. Timely and accurate reporting of this code can affect reimbursement and compliance.
2025 Updates and Policy Overview
CMS and MAC guidance updates
In 2025, Medicare Administrative Contractors (MACs) continue enforcing correct use of value code 82. According to Noridian and other MAC manuals, value code 82 is mandatory to report coinsurance days after day 60 in a benefit period and before day 91, when lifetime reserve days may begin :contentReference[oaicite:1]{index=1}.
Hospital‑at‑Home billing developments
Since July 1, 2022, the NUBC approved Occurrence Span Code 82 to capture hospital‑at‑home care dates during an inpatient stay. Hospitals billing under Type of Bill 11X must report this occurrence span code along with revenue code 0161 and value code 82 units matching those hospital‑at‑home days :contentReference[oaicite:2]{index=2}.
Why value code 82 Matters in 2025
Accurate value code 82 reporting impacts:
- Utilization review and cost outlier status determination in inpatient PPS claims
- Correct matching of covered and coinsurance days to avoid edits or denials
- Hospital‑at‑home billing compliance under the latest NUBC and CMS guidance
How to Report value code 82 Correctly
1. Calculate coinsurance days accurately
Medicare allows 60 covered days first. Days 61–90 are coinsurance days—enter total in value code 82. If lifetime reserve (LTR) days apply, those use value code 83 instead :contentReference[oaicite:3]{index=3}.
2. Align with occurrence span and revenue codes (for hospital‑at‑home)
When billing hospital‑at‑home, include occurrence span code 82 (dates of care) and revenue code 0161 with units equaling the days reported. The unit count under revenue code 0161 must match the value code 82 count :contentReference[oaicite:4]{index=4}.
3. Ensure sequence and field placement
List value codes in ascending order (80, 81, 82, 83) on the claim. Place the numeric value to the left of dollars/cents delimiter in FL 39–41 on the UB‑04 or electronic equivalent :contentReference[oaicite:5]{index=5}.
Tips to Avoid Common Errors
- Double‑check that day 60 isn’t included in value code 82 calculation.
- Verify occurrence span dates don’t include the discharge date if matching inpatient home‑care counts.
- Ensure claims using value code 82 always include value code 80 and, if needed, value codes 81 or 83.
- Use internal controls or system edits to flag mismatches between value code 82 units and revenue code 0161 units.
Examples and Use Cases
For example, a beneficiary hospitalized 85 days uses:
- 60 covered days → value code 80 = 60
- 25 coinsurance days → value code 82 = 25
- If hospital‑at‑home care occurred during days 65–68, those days are reported via occurrence span code 82 and revenue code 0161 with units = 4.
Internal & External Resources
For more on utilization and value code reporting, see CMS Claims Processing Manual. For coding policy discussion, AAPC’s modifier guidelines may help explain related CPT modifier 82 usage when a surgeon assistant is needed due to unavailable residents :contentReference[oaicite:6]{index=6}.
FAQ
What is the difference between value code 82 and occurrence span code 82?
Value code 82 reports total coinsurance days. Occurrence span code 82 reports actual dates of hospital‑at‑home care. They serve different billing contexts and should not be confused.
Do all inpatient claims require value code 82?
No. Only when coinsurance days (days 61‑90) are billed. If no coinsurance days exist or only covered days apply, omit value code 82.
Conclusion
To summarize, accurate use of value code 82 in 2025 is critical for proper Medicare Part A billing, cost‑outlier calculations, and hospital‑at‑home reimbursement compliance. Review policies regularly, validate day counts against system edits, and include internal controls to prevent claim denials. Visit our site for more guides on ICD‑10 coding tips, common denial reasons and prior authorization workflows.