Revenue Codes - JE Part A - Noridian (2024)

0001Total Charge001XPayer Code002XHealth Insurance Prospective Payment System (HIPPS)
0022 - Skilled Nursing Facility PPS
0023 - Home Health PPS
0024 - Inpatient Rehabilitation Facility (IRF) PPS010XAll-inclusive Rate
0100 - All inclusive room and board plus ancillary
0101 - All inclusive room and board011XRoom and Board Private (one bed)
0110 - General
0111 - Medical/Surgical/GYN
0112 - Obstetrics (OB)
0113 - Pediatric
0114 - Psychiatric
0115 - Hospice
0116 - Detoxification
0117 - Oncology
0118 - Rehabilitation
0119 - Other012XRoom and Board Semi-private (two beds)
0120 - General
0121 - Medical/Surgical/GYN
0122 - OB
0123 - Pediatric
0124 - Psychiatric
0125 - Hospice
0126 - Detoxification
0127 - Oncology
0128 - Rehabilitation
0129 - Other013XRoom and Board (3 and 4 beds)
0130 - General
0131 - Medical/Surgical/GYN
0132 - OB
0133 - Pediatric
0134 - Psychiatric
0135 - Hospice
0136 - Detoxification
0137 - Oncology
0138 - Rehabilitation
0139 - Other014XRoom and Board Deluxe Private
0140 - General
0141 - Medical/Surgical/GYN
0142 - OB
0143 - Pediatric
0144 - Psychiatric
0145 - Hospice
0146 - Detoxification
0147 - Oncology
0148 - Rehabilitation
0149 - Other015XRoom and Board Ward
0150 - General
0151 - Medical/Surgical/GYN
0152 - OB
0153 - Pediatric
0154 - Psychiatric
0155 - Hospice
0156 - Detoxification
0157 - Oncology
0158 - Rehabilitation
0159 - Other016XOther Room and Board
0160 - General
0161 - Hospital at home, R&B/hospital at home (effective for claims received on or after July 1, 2022)
0164 - Sterile
0167 - Self-care
0169 - Other017XNursery
0170 - General
0171 - Newborn Level I
0172 - Newborn Level II
0173 - Newborn Level III
0174 - Newborn Level IV
0179 - Other018XLeave of Absence
0180 - General
0182 - Patient convenience - charges billable
0183 - Therapeutic leave
0185 - Nursing home (for hospitalization)
0189 - Other019XSubacute Care
0190 - General
0191 - Level I
0192 - Level II
0193 - Level III
0194 - Level IV
0199 - Other020XIntensive Care Unit
0200 - General
0201 - Surgical
0202 - Medical
0203 - Pediatric
0204 - Psychiatric
0206 - Intermediate ICU
0207 - Burn Care
0208 - Trauma
0209 - Other021XCoronary Care Unit
0210 - General
0211 - Myocardial Infarction
0212 - Pulmonary Care
0213 - Heart Transplant
0214 - Intermediate CCU
0219 - Other Coronary CCU022XSpecial Charges
0220 - General
0221 - Admission Charge
0222 - Technical Support Charge
0223 - U.R. Service Charge
0224 - Late Discharge - Medically Necessary
0229 - Other023XIncremental Nursing Charge
0230 - General
0231 - Nursery
0232 - OB
0233 - ICU
0234 - CCU
0235 - Hospice
0239 - Other024XAll-inclusive Ancillary
0240 - General
0241 - Basic
0242 - Comprehensive
0243 - Specialty
0249 - Other025XPharmacy (Also see 063X, an extension of 250X)
0250 - General
0251 - Generic drugs
0252 - Non-generic drugs
0253 - Take-home drugs
0254 - Drugs incident to Other diagnostic services
0255 - Drugs incident to radiology
0256 - experimental drugs
0257 - Nonprescription
0258 - IV solutions
0259 - Other026XIV Therapy
0260 - General
0261 - Infusion pump
0262 - Pharmacy services
0263 - Drug/supply delivery
0264 - Supplies
0269 - Other027XMedical/Surgical Supplies and Devices (Also see 062X, an extension of 027X)
0270 - General
0271 - Nonsterile
0272 - Sterile
0273 - Take-home supplies
0274 - Prosthetic/orthotic devices
0275 - Pacemaker
0276 - Intraocular lens
0277 - Take-home oxygen
0278 - Other implants
0279 - Other supplies/devices028XOncology
0280 - General
0289 - Other029XDurable Medical Equipment (Other than Renal)
0290 - General
0291 - Rental
0292 - Purchase of new DME
0293 - Purchase of used DME
0294 - Supplies/Drugs for DME
0299 - Other equipment030XLaboratory
0300 - General
0301 - Chemistry
0302 - Immunology
0303 - Renal patient (home)
0304 - Nonroutine dialysis
0305 - Hematology
0306 - Bacteriology and Microbiology
0307 - Urology
0309 - Other031XLaboratory Pathology
0310 - General
0311 - Cytology
0312 - Histology
0314 - Biopsy
0319 - Other032XRadiology Diagnostic
0320 - General
0321 - Angiocardiography
0322 - Arthrography
0323 - Arteriography
0324 - Chest X-ray
0329 - Other033XRadiology Therapeutic and/of Chemotherapy Administration
0330 - General
0331 - Chemotherapy administration - injection
0332 - Chemotherapy administration - oral
0333 - Radiation therapy
0335 - Chemotherapy administration - IV
0339 - Other034XNuclear Medicine
0340 - General
0341 - Diagnostic
0342 - Therapeutic
0343 - Diagnostic radiopharmaceuticals
0344 - Therapeutic radiopharmaceuticals
0349 - Other035XCT Scan
0350 - General
0351 - Head scan
0352 - Body scan
0359 - Other036XOperating Room Services
0360 - General
0361 - Minor surgery
0362 - Organ transplant - other than kidney
0367 - Kidney transplant
0369 - Other037XAnesthesia
0370 - General
0371 - Incident to radiology
0372 - Incident to other diagnostic services
0374 - Acupuncture
0379 - Other038XBlood and Blood Products
0380 - General
0381 - Packed red cells
0382 - Whole blood and blood products
0383 - Plasma
0384 - Platelets
0385 - Leukocytes
0386 - Other components
0387 - Other derivatives (cryoprecipitates)
0389 - Other039XAdministration, Processing and Storage for Blood and Blood Components
0390 - General
0391 - Administration (e.g., transfusions)
0392 - Processing and storage
0399 - Other processing and storage040XOther Imaging Services
0400 - General
0401 - Diagnostic mammography
0402 - Ultrasound
0403 - Screening mammography
0404 - Positron Emission Tomography
0409 - Other041XRespiratory Services
0410 - General
0412 - Inhalation services
0413 - Hyperbaric oxygen therapy
0419 - Other042XPhysical Therapy
0420 - General
0421 - Visit charge
0422 - Hourly charge
0423 - Group rate
0424 - Evaluation or reevaluation
0429 - Other043XOccupational Therapy
0430 - General
0431 - Visit charge
0432 - Hourly charge
0433 - Group rate
0434 - Evaluation or reevaluation
0439 - Other044XSpeech Therapy Language Pathology
0440 - General
0441 - Visit charge
0442 - Hourly charge
0443 - Group rate
0444 - Evaluation or reevaluation
0449 - Other045XEmergency Room
0450 - General
0451 - EMTALA emergency medical screening services
0452 - ER beyond EMTALA screening
0456 - Urgent care
0459 - Other046XPulmonary Function
0460 - General
0469 - Other047XAudiology
0470 - General
0471 - Diagnostic
0472 - Treatment
0479 - Other048XCardiology
0480 - General
0481 - Cardiac cath lab
0482 - Stress test
0483 - Echocardiology
0489 - Other049XAmbulatory Surgical Care
0490 - General
0499 - Other050XOutpatient Services
0500 - General
0509 - Other051XClinic
0510 - General
0511 - Chronic pain center
0512 - Dental clinic
0513 - Psychiatric clinic
0514 - OB/GYN clinic
0515 - Pediatric clinic
0516 - Urgent care clinic
0517 - Family practice clinic
0519 - Other052XFreestanding Clinic
0520 - General
0521 - Clinic visit by member to RHC/FQHC
0522 - Home visit by RHC/FQHC practitioner
0523 - Family practice clinic
0524 - Visit by RHC/FQHC practitioner to member in a Part A covered stay in SNF
0525 - Visit by RHC/FQHC practitioner to member in a stay not covered by Part A in a
SNF, NF or ICF MR or other residential facility
0526 - Urgent care clinic
0527 - Visiting nurse services to member's home in a home health shortage area
0528 - Visit by RHC/FQHC practitioner to other non-RHC/FQHC site (e.g., scene of accident)
0529 - Other053XOsteopathic Services
0530 - General
0531 - Osteopathic therapy
0539 - Other054XAmbulance
0540 - General
0541 - Supplies
0542 - Medical transport
0543 - Heart mobile
0544 - Oxygen
0545 - Air ambulance
0546 - Neonatal ambulance
0547 - Pharmacy
0548 - EKG transmission
0549 - Other055XSkilled Nursing
0550 - General
0551 - Visit charge
0552 - Hourly charge
0559 - Other056XHome Health Medical Social Services
0560 - General
0561 - Visit charge
0562 - Hourly charge
0569 - Other057XHome Health Aide
0570 - General
0571 - Visit charge
0572 - Hourly charge
0579 - Other058XHome Health Other Visits
0580 - General
0581 - Visit charge
0582 - Hourly charge
0583 - Assessment
0589 - Other059XHome Health Units of Service
0590 - General060XHome Health Oxygen
0600 - General
0601 - Stat/Equip/Supply or contents
0602 - Stat/Equip/Supply Under 1 LPM
0603 - Stat/Equip Over 4 LPM
0604 - Portable Add-on
0609 - Other061XMagnetic Resonance Technology (MRT)
0610 - General
0611 - Brain/brain stem
0612 - Spinal cord/spine
0614 - Other MRI
0615 - Head and neck
0616 - Lower extremities
0618 - Other MRA
0619 - Other MRT062XMedical/Surgical Supplies - Extension of 027X
0621 - Incident to Radiology
0622 - Incident to Other Diagnostic services
0623 - Surgical Dressings
0624 - FDA investigational devices063XPharmacy - Extension of 025X
0631 - Single source drug
0632 - Multiple source drug
0633 - Restrictive prescription
0634 - Erythropoietin (EPO) less than 10,000 units
0635 - Erythropoietin (EPO) 10,000 or more units
0636 - Drugs requiring detailed coding
0637 - Self-administered drugs064XHome IV Therapy Services
0640 - General
0641 - Nonroutine nursing, central line
0642 - IV site care, central line
0643 - IV start/care, peripheral line
0644 - Nonroutine nursing, peripheral line
0645 - Training patient/caregiver, central line
0646 - Training disabled patient, central line
0647 - Training patient/caregiver, peripheral line
0648 - Training disabled patient, peripheral line
0649 - Other065XHospice Service
0650 - General
0651 - Routine home care
0652 - Continuous home care
0655 - Inpatient respite care
0656 - General inpatient care (non-respite)
0657 - Physician services
0658 - Hospice room and board - nursing facility
0659 - Other066XRespite Care
0660 - General
0661 - Hourly charge/nursing
0662 - Hourly charge/aide/homemaker/companion
0663 - daily respite charge
0669 - Other067XOutpatient Special Residence Charges
0670 - General
0671 - Hospital owned
0672 - Contracted
0679 - Other068XTrauma Response
0681 - Level I
0682 - Level II
0683 - Level III
0684 - Level IV
0689 - Other069XPre-Hospice/Palliative Care Services
0690 - General
0691 - Visit charge
0692 - Hourly charge
0693 - Evaluation
0694 - Consultation and education
0695 - Inpatient care
0696 - Physician services
0699 - Other070XCast Room
0700 - General071XRecovery Room
0710 - General072XLabor Room/Delivery
0720 - General
0721 - Labor
0722 - Delivery
0723 - Circumcision
0724 - Birthing center
0729 - Other073XEKG/ECG Electrocardiogram
0730 - General
0731 - Holter monitor
0732 - Telemetry
0739 - Other074XEEG Electroencephalogram
0740 - General075XGastrointestinal Services
0750 - General076XSpecialty Services
0760 - General
0761 - Treatment room
0762 - Observation hours
0769 - Other077XPreventive Services
0770 - General
0771 - Vaccine administration078XTelemedicine
0780 - General079XExtra-Corporeal Shock Wave Therapy (formerly Lithotripsy)
0790 - General080XInpatient Renal Dialysis
0800 - General
0801 - Inpatient hemodialysis
0802 - Inpatient peritoneal (non-CAPD)
0803 - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)
0804 - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)
0809 - Other081XAcquisition of Body Components
0810 - General
0811 - Living donor
0812 - Cadaver donor
0813 - Unknown donor
0814 - Unsuccessful organ search - donor bank charges
0815 - Stem cells - allogeneic (effective 1/1/17)
0819 - Other082XHemodialysis - Outpatient or Home
0820 - General
0821 - Composite or other rate
0822 - Home supplies
0823 - Home equipment
0824 - Maintenance/100%
0825 - Support Services
0829 - Other083XPeritoneal Dialysis - Outpatient or Home
0830 - General
0831 - Composite or other rate
0832 - Home supplies
0833 - Home equipment
0834 - Maintenance/100%
0835 - Support Services
0839 - Other084XContinuous Ambulatory Peritoneal Dialysis (CAPD)- Outpatient or Home
0840 - General
0841 - Composite or other rate
0842 - Home supplies
0843 - Home equipment
0844 - Maintenance/100%
0845 - Support Services
0849 - Other085XContinuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home
0850 - General
0851 - Composite or other rate
0852 - Home supplies
0853 - Home equipment
0854 - Maintenance/100%
0855 - Support Services
0859 - Other086XMagnetoencephalography
0860 - General
0861 - MEG087XCell/Gene Therapy
0870 - General
0871 - Cell Collection
0872 - Specialized Biologic Processing and Storage - Prior To Transport
0873 - Storage and Processing After Receipt of Cells from Manufacturer
0874 - Infusion of Modified Cells (Effective 4/1/19)
0875 - Injection of Modified Cells (Effective 4/1/19)088XMiscellaneous Dialysis
0880 - General
0881 - Ultrafiltration
0882 - Home dialysis aid visit
0889 - Other089XPharmacy - Extension of 025X and 063X
0890 - Reserved (Use 0250 For General Classification) (Effective 4/1/19)
0891- Special Processed Drugs - FDA Approved Cell Therapy (Effective 4/1/19)
0892 - Special Processed Drugs – FDA Approved Gene Therapy (Effective 4/1/20)090XBehavioral Health Treatments/Services (also see 091X, and extension of 090X)
0900 - General
0901 - Electroshock
0902 - Milieu therapy
0903 - Play therapy
0904 - Activity therapy
0905 - Intensive outpatient services - psychiatric
0906 - Chemical dependency
0907 - Community behavioral health program - day treatment091XBehavioral Health Treatments/Services - Extension of 090X
0911 - Rehabilitation
0912 - Partial hospitalization - less intensive
0913 - Partial hospitalization - intensive
0914 - Individual therapy
0915 - Group therapy
0916 - Family therapy
0917 - Biofeedback
0918 - Testing
0919 - Behavioral health treatments092XOther Diagnostic Services
0920 - General
0921 - Peripheral vascular lab
0922 - Electromyelogram
0923 - Pap smear
0924 - Allergy test
0925 - Pregnancy test
0929 - Other093XMedical Rehabilitation Day Program
0931 - Half day
0932 - Full day094XOther Therapeutic Services - See also 095X
0940 - General
0941 - Recreational
0942 - Education/training
0943 - Cardiac rehabilitation
0944 - Drug rehabilitation
0945 - Alcohol rehabilitation
0946 - Complex medical equipment - routine
0947 - Complex medical equipment - ancillary
0948 - Pulmonary rehabilitation
0949 - Other095XOther Therapeutic Services (Extension of 094X)
0951 - Athletic training
0952 – Kinesiotherapy
0953 - Chemical dependency (drug and alcohol)096XProfessional Fees
0960 - General
0961 - Psychiatric
0962 - Ophthalmology
0963 - Anesthesiologist (MD)
0964 - Anesthesiologist (CRNA)
0969 - Other097xProfessional Fees (Extension of 096X)
0971 - Laboratory
0972 - Radiology - diagnostic
0973 - Radiology - therapeutic
0974 - Nuclear medicine
0975 - Operating room
0976 - Respiratory therapy
0977 - Physical therapy
0978 - Occupational therapy
0979 - Speech pathology098XProfessional Fees (Extension of 096X and 097X)
0981 - Emergency room
0982 - Outpatient services
0983 - Clinic
0984 - Medical social services
0985 - EKG
0986 - EEG
0987 - Hospital visit
0988 - Consultation
0989 - Private-duty nurse099XPatient Convenience Items
0990 - General
0991 - Cafeteria/guest tray
0992 - Private linen service
0993 - Telephone/telegraph
0994 - TV/radio
0995 - Nonpatient room rentals
0996 - Late discharge charge
0997 - Admission kits
0998 - Beauty shop/barber
0999 - Other100XBehavioral Health Accommodations
1000 - General
1001 - Residential treatment - psychiatric
1002 - Residential treatment - chemical dependency
1003 - Supervised living
1004 - Halfway House
1005 - Group Home
1006 - Outdoor/wilderness behavioral health (effective 7/1/17)210XAlternative Therapy Services
2100 - General
2101 - Acupuncture
2102 - Acupressure
2103 - Massage
2104 - Reflexology
2105 - Biofeedback
2106 - Hypnosis
2109 - Other310XAdult Care
3101 - adult daycare, medical and social - hourly
3102 - Adult daycare, social - hourly
3103 - Adult daycare, medical and social - daily
3104 - Adult daycare, social - daily
3105 - Adult foster care - daily
3109 - Other