Introduction
Revenue code 0022 is essential in Skilled Nursing Facility (SNF) billing under the Medicare Prospective Payment System. In 2025, new payer rules and updated HIPPS reporting requirements make accurate use of revenue code 0022 more critical than ever. This guide shows you exactly what to know and how to bill correctly.
Overview of Revenue Code 0022
Revenue code 0022 identifies services billed under the SNF PPS structure using HIPPS rate codes. Medicare defines this code for all SNF Part A claims and it can appear multiple times on a claim when different assessment periods require different HIPPS codes :contentReference[oaicite:1]{index=1}.
2025 Updates & Billing Implications
CMS & MAC Changes for 2025
Effective 2025, Medicare Administrative Contractors reaffirmed that revenue code 0022 continues to report HIPPS rate codes per assessment period. The SNF PRICER uses submitted HIPPS codes and assessment days to calculate reimbursement accurately :contentReference[oaicite:2]{index=2}.
Common Edits & Claim Denials to Watch
- Noridian recently issued a warning: the billed covered units under code 0022 must match the covered units billed on other revenue lines (10X‑21X); mismatches may trigger denials :contentReference[oaicite:3]{index=3}.
- Claims with multiple 0022 lines must adhere to encounter span and occurrence code 50 reporting rules per NUBC standards and MAC guidance :contentReference[oaicite:4]{index=4}.
How to Bill Properly for Revenue Code 0022 (2025 Best Practices)
Submission Tips
- Use Type of Bill 21X (for SNF inpatient) or 18X (for swing‑bed) and include code 0022 lines for each HIPPS assessment period :contentReference[oaicite:5]{index=5}.
- Report the HIPPS rate code in SV202‑02 using ANSI 837I syntax, and units in SV205 matching covered days per assessment :contentReference[oaicite:6]{index=6}.
- Include occurrence code 50 on each 0022 line unless HIPPS AAA00 applies; this flags qualifying hospital stay span correctly :contentReference[oaicite:7]{index=7}.
- Ensure total charges are zero on 0022 lines—Medicare uses PRICER logic to set payment :contentReference[oaicite:8]{index=8}.
Documentation & Coding Pointers
Ensure Minimum Data Set (MDS) RUG/PDPM assessment documentation supports each HIPPS code reported. When therapy-intensive HIPPS groups are used, include required ancillary therapy revenue codes (042x, 043x, or 044x) or claims may be returned :contentReference[oaicite:9]{index=9}.
Impact on Billing Workflow & Payer Contracts
Revenue code 0022 signals complex care under SNF PPS and directly affects reimbursement. Documentation, claim build, and payer rules (such as private insurer variations) should align with HIPPS-based payment models. For contract rate negotiation, consulting national Medicare PRICER data helps benchmark private reimbursement trends :contentReference[oaicite:10]{index=10}.
Common Questions About Revenue Code 0022
Can you submit multiple 0022 lines on one claim?
Yes. Each represents a separate HIPPS assessment interval. Units billed must match days assigned to each HIPPS group on the claim :contentReference[oaicite:11]{index=11}.
What happens if covered units mismatch?
Claims may deny or generate a reason code. For example, Noridian reports mismatched units cause edits under Part A SNF billing :contentReference[oaicite:12]{index=12}.
Related Resources
For further reading, see these internal and external sources:
- Decoding the 0022 Revenue Code: Understanding Intensive Care Billing – deep dive into classification and documentation.
- Review CMS MLN SNF Billing Reference for official Medicare billing instructions.
- Consult CMS 2025 SNF PPS Pricer guidance for reimbursement calculations and HIPPS rules.
Conclusion
Revenue code 0022 remains integral to SNF PPS billing in 2025. Accurate HIPPS reporting, matching covered units, and following Medicare guidelines ensure clean claims and proper reimbursement. Staying current with MAC bulletins and payer rules improves workflow and reduces denials. Bookmark this guide and apply these tips in your revenue cycle processes today.
If you work with ICD‑10 coding or claim denial resolution, check out our ICD-10 coding tips and explore our internal guides on common denial reasons to deepen your billing expertise.