As a reminder, Anthem Blue Cross and Blue Shield continues to require the submission of value codes and the value code amounts (FL39 - FL41) on all inpatient facility claims when submitting private room revenue codes (011x and 014x).  This requirement continues to align with industry standards implemented in March 2007 for UB-04 claims by the Centers for Medicare & Medicaid Services (CMS) and the National Uniform Billing Committee (NUBC).


The value codes to be submitted when billing private room revenue codes according to the UB-04 Specifications Manual are:


  • “01” (semi-private room facility) must be accompanied by the semi-private room rate when facility offers semi-private rooms and the patient’s stay is in a private room


  • “02” indicating “private room only” facility with $0.00 when the facility is private room only


If the facility has semi-private rooms but none is available report “condition code” 38 or if a private room is medically necessary, report “condition code” 39 (FL-18 - FL28).


Below is a listing of the private room revenue codes that will require a Value code of “01” with the average semi-private room rate or “02” with $0.00.


011x or 014x Room and Board-Private (Medical or General) Revenue Codes


Note: Routine service charges for single bedrooms. Rationale: Most third party payers require that private rooms be separately identified.



Standard Abbreviations

0 – General Classification

Room-Board/ PVT

1 – Medical/Surgical/GYN


2 - OB


3 - Pediatric


4 - Psychiatric


5 - Hospice


6 - Detoxification


7 - Oncology


8 – Rehabilitation


9 – Other






Featured In:
April 2019 Anthem Provider Newsletter - Virginia