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December 2016 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 1 General Information : 1.2 Revenue Codes for UB-04 Submissions

1.2
Claims that are submitted on the CMS-1450 UB-04 paper claim form or electronic equivalent by non-hospital facility or other non-hospital providers must be submitted with a revenue code for correct processing.
If the non-hospital provider is required to submit a procedure code for reimbursement, the provider must include the procedure code and an appropriate corresponding revenue code on the same detail, even if the chosen revenue code does not require a procedure code for claims processing.
Refer to:
Subsection 4.5.5, “Outpatient Hospital Revenue Codes” in Inpatient and Outpatient Hospital Services Handbook (Vol. 2, Provider Handbooks) for a list of revenue codes that do and do not require procedure codes.

Texas Medicaid & Healthcare Partnership
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