26.3.2.2 Revenue s (Outpatient Hospital) HCFA-1450 (UB-92) revenue codes must be used to bill outpatient hospital facility services. In some instances, a HCPCS procedure code is required in addition to the revenue code for accurate claims processing: Revenue B-250 General classification B-251 Generic drugs B-252 Non-generic drugs Pharmacy B-253 Take Home drugs Not a benefit B-254 Drugs incident to other diagnostic services B-255 Drugs incident to radiology B-256 Experimental drugs Not a benefit B-257 Nonprescription drugs B-258 IV solutions B-259 Other pharmacy B-630* Drugs requiring specific identification HCPCS code required B-631* Single source drug HCPCS code required B-632* Multiple source drug HCPCS code required B-633* Restrictive prescription HCPCS code required B-634* Erythropoietin (EPO) less than 10,000 units HCPCS code required B-635* Erythropoietin (EPO) 10,000 or more units HCPCS code required B-636* Drugs requiring detailed coding HCPCS code required B-637 Self-administrable drugs Not a benefit B-260 General classification B-261 Infusion pump B-262 IV therapy/pharmacy services B-263 IV therapy/drug/supply delivery B-264 IV therapy/supplies B-269 Other IV therapy B-270 General classification B-271 Nonsterile supply B-272 Sterile supply IV Therapy Medical/Surgical Supplies and Devices B-273 Take-home supplies Not a benefit B-274* Prosthetic/orthotic devices HCPCS code required
B-275 Pacemaker B-276 Intraocular lens B-277 Oxygen take-home Not a benefit B-278* Other implants HCPCS code required B-279* Other supplies/devices HCPCS code required B-620* Medical/surgical supplies HCPCS code required B-621 Supplies incident to radiology B-622 Supplies incident to other diagnostic services B-623 Surgical dressings B-624 FDA investigational devices Not a benefit B-280 General classification B-289 Other oncology Oncology Laboratory B-300* General classification HCPCS code required B-301* Chemistry HCPCS code required B-302* Immunology HCPCS code required B-303* Renal patient (home) HCPCS code required B-304* Nonroutine dialysis HCPCS code required B-305* Hematology HCPCS code required B-306* Bacteriology and microbiology HCPCS code required B-307* Urology HCPCS code required B-309* Other laboratory HCPCS code required Laboratory Pathological B-310* General classification HCPCS code required B-311* Cytology HCPCS code required B-312* Histology HCPCS code required B-314* Biopsy HCPCS code required B-319* Other pathology HCPCS code required Radiology Diagnostic B-320* General classification HCPCS code required B-321* Angiocardiography HCPCS code required B-322* Arthrography HCPCS code required B-323* Arteriography HCPCS code required B-324* Chest X-ray HCPCS code required B-329* Other diagnostic radiology HCPCS code required
Radiology - Therapeutic B-330* General classification HCPCS code required B-331* Chemotherapy injected HCPCS code required B-332* Chemotherapy oral HCPCS code required B-333* Chemotherapy radiation therapy HCPCS code required B-335* Chemotherapy IV HCPCS code required B-339* Other therapeutic radiology HCPCS code required Nuclear Medicine B-340* General classification HCPCS code required B-341* Diagnostic HCPCS code required B-342* Therapeutic HCPCS code required B-349* Other nuclear medicine HCPCS code required CT Scan B-350* General classification HCPCS code required B-351* Head scan HCPCS code required B-352* Body scan HCPCS code required B-359* Other CT scans HCPCS code required B-360 General classification B-361 Minor surgery B-369 Other operating room services B-370 General classification B-371 Anesthesia incident to radiology Operating Room Services Anesthesia B-372 Anesthesia incident to other diagnostic services B-374 Acupuncture Not a benefit B-379 Other anesthesia Blood B-380* General classification HCPCS code required B-381* Packed red cells HCPCS code required B-382* Whole blood HCPCS code required B-383* Plasma HCPCS code required B-384* Platelets HCPCS code required B-385* Leucocytes HCPCS code required B-386* Other components HCPCS code required B-387* Other derivatives (cryoprecipitates) HCPCS code required
B-389* Other blood HCPCS code required B-390 General classification Blood Storage and Processing B-391 Blood administration Not a benefit B-399 Other blood storage and processing Not a benefit Other Imaging Services B-400* General classification HCPCS code required B-401* Diagnostic mammography HCPCS code required B-402* Ultrasound HCPCS code required B-403* Screening mammography HCPCS code required B-404* Positron emission tomography HCPCS code required B-409* Other imaging services HCPCS code required B-410 General classification B-412 Inhalation services B-413 Hyperbaric oxygen therapy Respiratory Services B-419* Other respiratory services HCPCS code required Physical Therapy B-420* General classification HCPCS code required B-421* Visit charge HCPCS code required B-422* Hourly charge HCPCS code required B-423* Group rate HCPCS code required B-424* Evaluation or re-evaluation HCPCS code required B-429* Other physical therapy HCPCS code required Occupational Therapy B-430* General classification HCPCS code required B-431* Visit charge HCPCS code required B-432* Hourly charge HCPCS code required B-433* Group rate HCPCS code required B-434* Evaluation or re-evaluation HCPCS code required B-439* Other occupational therapy HCPCS code required Speech-Language Pathology B-440* General classification HCPCS code required B-441* Visit charge HCPCS code required B-442* Hourly charge HCPCS code required B-443* Group rate HCPCS code required
B-444* Evaluation or re-evaluation HCPCS code required B-449* Other speech-language pathology HCPCS code required B-450 General classification B-456 Urgent care B-459 Other emergency room Emergency Room Pulmonary Function B-460* General classification HCPCS code required B-469* Other pulmonary function HCPCS code required Audiology B-470* General classification HCPCS code required B-471* Diagnostic HCPCS code required B-472* Treatment HCPCS code required B-479* Other Audiology HCPCS code required Cardiology B-480* General classification HCPCS code required B-481* Cardiac cath lab HCPCS code required B-482* Stress test HCPCS code required B-489* Other cardiology HCPCS code required B-510 General classification B-511 Chronic pain center B-512 Dental clinic B-513 Psychiatric clinic B-514 OB-GYN clinic B-515 Pediatric clinic B-516 Urgent Care clinic B-517 Family Practice clinic B-519 Other clinic B-520 General classification B-523 Family practice clinic B-526 Urgent care clinic B-529 Other freestanding clinic Clinic Freestanding Clinic Magnetic Resonance Technology (MRT) B-610* General classification HCPCS code required
B-611* MRI brain (including brainstem) HCPCS code required B-612* MRI spinal cord (including spine) HCPCS code required B-619* Other MRT HCPCS code required B-700 General classification B-709 Other cast room B-710 General classification B-719 Other recovery room B-720 General classification B-721 Labor B-722 Delivery B-723 Circumcision B-724 Birthing center B-729 Other labor room/delivery Cast Room Recovery Room Labor Room/Delivery EKG/ECG (Electrocardiogram) B-730* General classification HCPCS code required B-731* Holter monitor HCPCS code required B-732* Telemetry HCPCS code required B-739* Other EKG/ECG HCPCS code required EEG (Electroencephalogram) B-740* General classification HCPCS code required B-749* Other EEG HCPCS code required B-750 General classification B-759 Other gastrointestinal B-760 General classification B-761 Treatment room B-762 Observation room B-769 Other treatment/observation room Gastrointestinal Services Treatment or Observation Room Preventive Care Services B-770* General classification HCPCS code required B-771* Vaccine administration HCPCS code required B-779* Other preventive care services HCPCS code required
Lithotripsy B-790* General classification HCPCS code required B-799* Other lithotripsy HCPCS code required Other Diagnostic Services B-920* General classification HCPCS code required B-921* Peripheral vascular lab HCPCS code required B-922* Electromyelogram HCPCS code required B-923* Pap smear HCPCS code required B-924* Allergy test HCPCS code required B-925* Pregnancy test HCPCS code required B-929* Other diagnostic service HCPCS code required * HCPCS procedure code is required in addition to revenue code for accurate claims processing.