Billing for private room stays

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.

 

Subcategory	Standard Abbreviations
0 – General Classification	Room-Board/ PVT
1 – Medical/Surgical/GYN	MED-SUR-GYN/PVT
2 - OB	OB/PVT
3 - Pediatric	PEDS/PVT
4 - Psychiatric	PSYCH/PVT
5 - Hospice	HOSPICE/PVT
6 - Detoxification	DETOX/PVT
7 - Oncology	ONCOLOGY/PVT
8 – Rehabilitation	REHAB/PVT
9 – Other	OTHER/PVT