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October 2014 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4. Outpatient Hospital (Medical and Surgical Acute Care Outpatient Facility) : 4.5 Claims Filing and Reimbursement : 4.5.5 Outpatient Hospital Revenue Codes

4.5.5
UB‑04 CMS-1450 revenue codes must be used to submit claims for outpatient hospital facility services. In some instances, a HCPCS procedure code is required in addition to the revenue code for accurate claims processing:
Speech-language pathology- evaluation/reevaluation
Drugs requiring specific identification, erythropoietin (EPO) less than 10,000 units
Drugs requiring specific identification, erythropoietin (EPO) 10,000 or more units

Texas Medicaid & Healthcare Partnership
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