This article explains how to bill Value Codes (FL39–FL41) and Revenue Codes (FL42) on the UB-04 claim form (CMS-1450). You will learn what each code set represents, where to enter them, common codes and their meanings, step-by-step billing instructions, payer nuances, and a comprehensive FAQ. Throughout, we reference CMS’s official manuals and expert guidance to ensure your claims are compliant and optimized for payment.
Understanding Value Codes (Form Locators 39–41)
In addition, value codes are used to report non-chargeable claim data, such as covered days or coinsurance days.
Definition & Purpose
- Value Codes report additional claim details not captured by charges alone (e.g., number of covered days) CMS.
- They must be entered in FL39 (Code) and FL40 (Amount) for the first pair, and FL41 for the second pair CMS.
Common Value Codes
| Code | Title | Usage Example |
|---|---|---|
| 80 | Covered Days | Number of days Medicare covered in period AAPC |
| 81 | Non-covered Days | Days not covered by insurance |
| 82 | Coinsurance Days | Days subject to coinsurance |
| 83 | Lifetime Reserve Days Used | Days of Lifetime Reserve used |
| 86 | PPS Per Diem Rate | Daily rate under Prospective Payment System |
For a complete list, see the NUBC’s Official UB-04 Data Specifications Manual NUBC.
Understanding Revenue Codes (Form Locator 42)
Revenue codes are four-digit codes that categorize the type of service or accommodation billed.
Definition & Purpose
- Revenue Codes identify departmental services (e.g., pharmacy, radiology) and appear in FL42 alongside associated charges in FL47 CMS.
- They align with NUBC categories, enabling payers to apply correct payment rules NUBC.
Common Revenue Code Ranges
| Range | Category | Example Code |
|---|---|---|
| 0100–0199 | Room & Board | 0120 (Med/Surg R&B) |
| 0250–0289 | Pharmacy | 0250 (Pharmacy) |
| 0300–0399 | Labs & Radiology | 0329 (CT Scans) |
| 0360–0369 | Operating Room | 0361 (OR Major) |
| 0450–0459 | Emergency Department | 0450 (ER Services) |
Refer to Chapter 25 of the CMS Claims Processing Manual for full listings CMS.
How to Bill Value and Revenue Codes: Step-by-Step
1. Identify Services and Days
- Review clinical documentation to determine covered/non-covered days.
- Consult the chargemaster to map services to correct revenue codes.
2. Enter Value Codes (FL39–FL41)
- FL39 (Value Code a)
- Enter code (e.g., “80” for covered days) AAPC.
- FL40 (Amount a)
- Enter numeric amount (e.g., “05” for five days) AAPC.
- FL41 (Value Code b & Amount b) if reporting a second value.
3. Enter Revenue Codes (FL42) and Charges (FL47)
- FL42: List each four-digit revenue code for each line item CMS.
- FL47: Enter corresponding dollar charge for each revenue code CMS.
- Total Line: Use revenue code “0001” in FL42 to sum total charges if required CMS.
4. Include CPT/HCPCS (FL44) When Required
- For certain revenue ranges (e.g., 0120–0139, 0300–0399, 0360–0369), include the procedure code in FL44 on the same line to avoid denials AAPC.
Payer-Specific Considerations
Medicare
- Value Codes: Must use codes 80–83 for days; amount must be whole numbers AAPC.
- Revenue Codes: NUBC-approved only; missing codes trigger rejection by A/B MACs CMS.
Medicaid
- Some state Medicaid programs require specific value codes beyond 80–83 (e.g., code 86 for per diem) AAPC.
- Error “MISSING OR INVALID VALUE CODE OR VALUE CODE AMOUNT” often indicates a mismatch between expected code and amount format AAPC.
Commercial Insurers (e.g., UnitedHealthcare, Anthem)
- UnitedHealthcare: Surgical revenue codes (0360–0369) must pair with CPT/HCPCS in FL44 AAPC.
- Anthem: Pharmacy revenue codes (0250–0259) require matching HCPCS; otherwise, claims may deny AAPC.
FAQ
Q1: Can I leave Value Code fields blank if not applicable?
No. If no value codes apply, enter “88” (Not Applicable) in FL39 and “0” in FL40 to avoid missing-field edits CMS.
Q2: What if multiple services share the same revenue code?
List each service line separately with the same revenue code but different charges; do not aggregate in one line CMS.
Q3: How often do Value and Revenue Codes change?
- Value Codes: Rarely change; updates occur only with new program requirements (e.g., PPS per diem) CMS.
- Revenue Codes: Updated annually (effective July 1) in the NUBC manual NUBC.
Q4: Is there an official source for code definitions?
Yes. The Official UB-04 Data Specifications Manual by the NUBC is the authoritative source for both value and revenue codes NUBC.
Q5: What are common errors to avoid?
- Incorrect FL39/FL40 pairing (code without amount) AAPC.
- Omitting CPT/HCPCS when payer policy requires it AAPC.
- Using outdated revenue codes not in the current NUBC manual NUBC.