Resolved Revenue codes

[MistyR_46049]

Hello,

I am trying to determine the correct revenue codes for Medi-Cal Rural Health clinics billing on the UB form. I am seeing for the J codes 250 or 771, State issue penny charges for the 9 series vaccines at 250, and 771 for the administrative codes, and non-state owned vaccine 9 series codes with Rev code 636 which I thought was IP only but I am seeing it for OP rural health clinic, also am seeing 636 on the J codes and cant tell why some J codes are 250 and some are 636. Is there a way to confirm the revenue codes for the UB rural health clinic ones?

Thanks,

 

[Lori]

What is Medi Cal revenue Code 636?

We know that for Medicare claims, Revenue Code 636 is used for: 1) Inpatient – exclusively billing hemophilia clotting factors. 2) Outpatient – billing for "Drugs that require detail coding" (i.e., pharmacy with HCPCS)

Applicable Revenue Codes. --Bill for the vaccines using revenue code 636. Bill for the administration of the vaccine using revenue code 771.

What does revenue Code 250 mean?

There are several ways revenue code 250 can be used for billing outpatient medications. The first pertains to billing for a covered medication which does not have a valid HCPCS or CPT code. In this instance, revenue code 250 may be billed without a corresponding code.

Medi-Cal Provider Training 2023

https://files.medi-cal.ca.gov/pubsdoco/outreach_education/workbooks/workbook_bb.pdf

 

[MistyR_46049]

Thank you

 

[MistyR_46049]

What is Medi Cal revenue Code 636?

We know that for Medicare claims, Revenue Code 636 is used for: 1) Inpatient – exclusively billing hemophilia clotting factors. 2) Outpatient – billing for "Drugs that require detail coding" (i.e., pharmacy with HCPCS)

Applicable Revenue Codes. --Bill for the vaccines using revenue code 636. Bill for the administration of the vaccine using revenue code 771.

What does revenue Code 250 mean?

There are several ways revenue code 250 can be used for billing outpatient medications. The first pertains to billing for a covered medication which does not have a valid HCPCS or CPT code. In this instance, revenue code 250 may be billed without a corresponding code.

Medi-Cal Provider Training 2023

https://files.medi-cal.ca.gov/pubsdoco/outreach_education/workbooks/workbook_bb.pdf

So if its apart of the VFC program then it be billed with the 636 revenue code? Is their a way to locate revenue codes by CPT code etc.

 

[Lori]

So if its apart of the VFC program then it be billed with the 636 revenue code? Is their a way to locate revenue codes by CPT code etc.

STATE PROGRAMS​

Some physician practices participate in state-sponsored Vaccines for Children (VFC) programs. Because the state generally provides the practice with the vaccines, physicians may not charge beneficiaries for the vaccines and physicians are not separately reimbursed by Medicaid or commercial carriers.

However, providers may charge patients for the administration fee associated with providing the vaccine. For vaccines provided as part of the VFC program, the CPT® code range is 90476 — 90749, with modifier SL appended in the first reporting modifier field.

Accurate Coding for Vaccines | 90471, 90472 and more| - Healthcare Revenue Cycle Management Solutions | Pararev

Vaccines are common outpatient procedures, but they can be complex to code and undetected mistakes can result in underpayment for services rendered.

www.pararevenue.com

Applicable Revenue Codes. --Bill for the vaccines using revenue code 636. Bill for the administration of the vaccine using revenue code 771.

Because the VFC program provides vaccine/toxoid product(s) at no cost to a VFC provider, Medi-Cal will only reimburse a VFC provider for the cost of administering a VFC dose and not for the dose itself. According to national CPT® code guidelines, immunization services are usually reported by using both the vaccine/toxoid code(s) and the vaccine immunization administration code(s). To report a VFC immunization service to Medi-Cal, providers should list each administered vaccine/toxoid product code with a modifier code of “SL,” which identifies the dose as a “state-supplied vaccine”. A separate VFC administration fee will be reimbursed for each vaccine/toxoid product code that is listed with an “SL” modifier on the claim.

Medi-Cal does not reimburse for the cost of a vaccine product that is available through the VFC program but purchased from a non-VFC source and administered to a VFC-eligible person except when justified. A provider’s non-enrollment in the VFC program is not a justified exception. Valid exceptions include documented cases of a VFC vaccine supply shortage due to a disease epidemic, vaccine manufacturing or delivery problems, or instances when the beneficiary does not meet special circumstances required by the VFC program for the vaccine billed. Providers must indicate a justified exception requiring the administration of a non-VFC dose in the Remarks field (Box 80)/Additional Claim Information(Box 19) of the claim.

https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/vaccine.pdf

Revenue Codes - JE Part A - Noridian

med.noridianmedicare.com

https://static.cigna.com/assets/chcp/pdf/resourceLibrary/medical/revenue-code-list-requiring-cpt-and-hcpcs-codes-for-outpatient-facility-claims.pdf

Please see this thread.

Resolved - Revenue Codes

What is a Revenue Code? Revenue codes are a standardized system that identifies any accommodations and specific services provided to patients in a healthcare setting. These services may include room and board, imaging services, medications, & more. These codes not only tell the insurance...

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