If the revenue code you are looking for does not appear on this list, then it does not require a HCPCS code for the TRICARE North region.
Revenue Codes:
0240 – All Inclusive Ancillary, General Classification = Legacy COS 086 or 087 based on Taxonomy Code
0180 - Leave of Absence days, General Classification = Legacy BR codes 70 & 71
0182 – Leave of Absence Days, Patient Convenience = Legacy BR codes 70 & 71
0183 – Leave of Absence Days, Therapeutic = Legacy BR codes 70 & 71
0185 – Leave of Absence Days, Hospitalization = Legacy BR codes 60 & 61
HCPCS/Revenue Code Chart
A-01-93, A-01-50, A-03-066
The following chart reflects HCPCS coding to be reported under OPPS by hospital outpatient departments. This chart is intended only as a guide to be used by hospitals to assist them in reporting services rendered. Hospitals that are currently utilizing different revenue/HCPCS reporting may continue to do so. They are not required to change the way they currently report their services to agree with this chart. Note that this chart does not represent all HCPCS coding subject to OPPS.
HCPCS Code - D0150, D0240-D0274 - Dental Services
UB-92 Billing Instructions for Inpatient Chemical Dependency Services General Instructions The placing authority (county or tribe) authorizes Chemical Dependency services for eligible recipients. Bill for services after you receive an accurate notification letter from the county or tribe. If any of the information is inaccurate (units, rate, procedure codes, start or end dates, etc.), contact the county or tribe. Once the correction has been made, you will receive an updated notification letter. Use the information from the notification in conjunction with these UB-92 claim form instructions to submit your claims. Bill for services only after they have been provided. Do not bill for future dates.
Inpatient Services include all residential chemical dependency treatment: Primary inpatient Halfway house Extended care Housing Use only the following revenue codes: 0100, 0240 & 0120, 0241 & 0110, 0243 & 0150 and Bill both treatment and room & board services for the same time span on separate claim forms. For example, bill the entire treatment authorization span on one claim and the room & board authorization span on another claim. You may also bill each authorization by a single or multiple calendar month(s).
IMPORTANT:This table does NOT apply to ambulatory surgery billing.
| RevenueCode | HCPCS Code Range | ||||||
| 0240 | A0001 | Z9999 | |||||
| 0240 | 00001 | 99999 | |||||
| 0241 | A0001 | Z9999 | |||||
| 0241 | 00001 | 99999 | |||||
| 0242 | A0001 | Z9999 | |||||
| 0242 | 00001 | 99999 | |||||
| 0243 | A0001 | Z9999 | |||||
| 0243 | 00001 | 99999 | |||||
| 0256 | A0001 | Z9999 | |||||
| 0256 | 00001 | 99999 | |||||
| 0279 | A0001 | Z9999 | |||||
| 0279 | 00001 | 99999 | |||||
| 0290 | A0001 | Z9999 | |||||
| 0290 | 00001 | 99999 | |||||
| 0291 | A0001 | Z9999 | |||||
| 0291 | 00001 | 99999 | |||||
| 0292 | A0001 | Z9999 | |||||
| 0292 | 00001 | 99999 | |||||
| 0293 | A0001 | Z9999 | |||||
| 0293 | 00001 | 99999 | |||||
| 0294 | A0001 | Z9999 | |||||
| 0294 | 00001 | 99999 | |||||
| 0299 | A0001 | Z9999 | |||||
| 0299 | 00001 | 99999 | |||||
| 0300 | A0001 | Z9999 | |||||
| 0300 | 00001 | 99999 | |||||
| 0301 | A0001 | Z9999 | |||||
| 0301 | 00001 | 99999 | |||||
| 0302 | A0001 | Z9999 | |||||
| 0302 | 00001 | 99999 | |||||
| 0303 | A0001 | Z9999 | |||||
| 0303 | 00001 | 99999 | |||||
| 0304 | A0001 | Z9999 | |||||
| 0304 | 00001 | 99999 | |||||
| 0305 | A0001 | Z9999 | |||||
| 0305 | 00001 | 99999 | |||||
| 0306 | A0001 | Z9999 | |||||
| 0306 | 00001 | 99999 | |||||
| 0307 | A0001 | Z9999 | |||||
| 0307 | 00001 | 99999 | |||||
| 0309 | A0001 | Z9999 | |||||
| 0309 | 00001 | 99999 | |||||
| 0310 | A0001 | Z9999 | |||||
| 0310 | 00001 | 99999 | |||||
| 0311 | A0001 | Z9999 | |||||
| 0311 | 00001 | 99999 | |||||
| 0312 | A0001 | Z9999 | |||||
| 0312 | 00001 | 99999 | |||||
| 0314 | A0001 | Z9999 | |||||
| 0314 | 00001 | 99999 | |||||
| 0319 | A0001 | Z9999 | |||||
| 0319 | 00001 | 99999 | |||||
| 0320 | A0001 | Z9999 | |||||
| 0320 | 00001 | 99999 | |||||
| 0321 | A0001 | Z9999 | |||||
| 0321 | 00001 | 99999 | |||||
| 0322 | A0001 | Z9999 | |||||
| 0322 | 00001 | 99999 | |||||
| 0323 | A0001 | Z9999 | |||||
| 0323 | 00001 | 99999 | |||||
| 0324 | A0001 | Z9999 | |||||
| 0324 | 00001 | 99999 | |||||
| 0329 | A0001 | Z9999 | |||||
| 0329 | 00001 | 99999 | |||||
| 0330 | A0001 | Z9999 | |||||
| 0330 | 00001 | 99999 | |||||
| 0333 | A0001 | Z9999 | |||||
| 0333 | 00001 | 99999 | |||||
| 0339 | A0001 | Z9999 | |||||
| 0339 | 00001 | 99999 | |||||
| 0340 | A0001 | Z9999 | |||||
| 0340 | 00001 | 99999 | |||||
| 0341 | A0001 | Z9999 | |||||
| 0341 | 00001 | 99999 | |||||
| 0342 | A0001 | Z9999 | |||||
| 0342 | 00001 | 99999 | |||||
| 0349 | A0001 | Z9999 | |||||
| 0349 | 00001 | 99999 | |||||
| 0350 | A0001 | Z9999 | |||||
| 0350 | 00001 | 99999 | |||||
| 0351 | A0001 | Z9999 | |||||
| 0351 | 00001 | 99999 | |||||
| 0352 | A0001 | Z9999 | |||||
| 0352 | 00001 | 99999 | |||||
| 0359 | A0001 | Z9999 | |||||
| 0359 | 00001 | 99999 | |||||
| 0360 | A0001 | Z9999 | |||||
| 0360 | 00001 | 99999 | |||||
| 0361 | A0001 | Z9999 | |||||
| 0361 | 00001 | 99999 | |||||
| 0362 | A0001 | Z9999 | |||||
| 0362 | 00001 | 99999 | |||||
| 0367 | A0001 | Z9999 | |||||
| 0367 | 00001 | 99999 | |||||
| 0369 | A0001 | Z9999 | |||||
| 0369 | 00001 | 99999 | |||||
| 0374 | A0001 | Z9999 | |||||
| 0374 | 00001 | 99999 | |||||
| 0380 | A0001 | Z9999 | |||||
| 0380 | 00001 | 99999 | |||||
| 0381 | A0001 | Z9999 | |||||
| 0381 | 00001 | 99999 | |||||
| 0382 | A0001 | Z9999 | |||||
| 0382 | 00001 | 99999 | |||||
| 0383 | A0001 | Z9999 | |||||
| 0383 | 00001 | 99999 | |||||
| 0384 | A0001 | Z9999 | |||||
| 0384 | 00001 | 99999 | |||||
| 0385 | A0001 | Z9999 | |||||
| 0385 | 00001 | 99999 | |||||
| 0386 | A0001 | Z9999 | |||||
| 0386 | 00001 | 99999 | |||||
| 0387 | A0001 | Z9999 | |||||
| 0387 | 00001 | 99999 | |||||
| 0389 | A0001 | Z9999 | |||||
| 0389 | 00001 | 99999 | |||||
| 0400 | A0001 | Z9999 | |||||
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