What are value codes in medical billing?
Asked by: Charlotte Swift | Last update: July 19, 2025Score: 4.7/5 (15 votes)
What are value codes 48 and 49?
Effective January 1, 2006 the definition of value code 48 is changed to indicate the patient's most recent hemoglobin reading taken before the start of the billing period. 49 - Hematocrit Reading - Code indicates the hematocrit reading taken before the last administration of EPO during this billing cycle.
What does value code 12 mean?
1 VALUE CODES FL 39-41 Enter the value codes “12” to indicate Working Aged insurance, or “43” to indicate Disability insurance and the amount you were paid by the primary insurance.
What is value code 01 and 02?
01. Most common Semi-Private Rate - to provide for recording hospital's most common semi- private rate. 02. Hospital has no semi-private rooms - using this code requires $0.00 amount.
What does value code 44 mean?
The VC 44 is reported only if a provider is expecting to receive a payment after a primary payment has been made through a (preferred provider) contractual arrangement. The VC 44 should not be reported when: Providers have failed to file a proper claim to the primary payer.
What are Revenue Codes in Medical Billing?
What is a value code in billing?
Value codes are required on an institutional claim to identify data elements such as: Medicare lifetime reserve days, no-fault payments, and the number of days not covered by the primary payer.
What is value code 37?
37 - Pints of Blood Furnished - Code indicates the total number of pints of blood or units of packed red cells furnished, whether or not replaced. Blood is reported only in terms of complete pints rounded upwards, e.g., 1 1/4 pints is shown as 2 pints.
What is Medicare value code 17?
Value Codes
17- Operating Outlier Amount – The A/B MAC (A) reports the amount of operating outlier payment amount made (either cost or day (day outliers have been obsolete since 1997)) in CWF with this code. It does not include any capital outlier payment in this entry.
What is value code 80?
Value Codes: 80 – Covered days. 81 – Non-covered days. 82 – Coinsurance days.
What is the value code 24?
The new data circled in the green box is the new information to be used for billing. The Value Code and Value Code Amount are data elements that identify essential information to pay a claim. The “Value Code” of “24” stands for the “Medicaid Rate Code”.
What is value code 16?
16. PHS, Other Federal Agency. That portion of a higher priority PHS or other Federal agency's payment, made on behalf of a Medicare beneficiary that the provider is applying to covered Medicare charges. NOTE: A six zero value entry for Value Codes 12-16 indicates conditional Medicare payment requested (000000).
What is medical value code 45?
Denial code 45 is used when the charge for a service exceeds the fee schedule, maximum allowable amount, or the contracted/legislated fee arrangement. This means that the amount being charged for the service is higher than what is allowed or agreed upon by the payer.
What is value code 51?
51 Occupational therapy visits - Indicates the number of occupational therapy visits from onset (at the billing provider) through this billing period. 52 Speech therapy visits - Indicates the number of speech therapy visits from onset (at billing provider) through this billing period.
What are value codes 61?
Value Codes and Amounts
The most commonly used value codes on hospice claims are 61 and G8, which are used to report the location of the site of hospice services. Otherwise, value codes are commonly used only to indicate Medicare is secondary to another payer.
What is value code 85?
CR 10782 established value code (VC) 85 and an associated Federal Information Processing Standards (FIPS) state and county code for this requirement. VC 85 is defined as "County Where Service is Rendered."
What is value code 68 on ub04?
68 - Erythropoietin Units - Code indicates the number of units of administered EPO relating to the billing period and reported in whole units to the left of the dollar/cents delimiter. NOTE: The total amount of EPO injected during the billing period is reported.
What is Medicare value code 74?
Applicable Medi-Cal codes are: Enter code “74” (Non-Covered Level of Care/Leave of Absence Dates) if the claim is for a Leave of Absence of any type. Enter code “M4” (Residential Level of Care) if the claim is for Leave of Absence to the patient's home and the patient has not been discharged.
What is a code 80?
Merchants who receive a chargeback for a transaction placed with a Visa card may encounter reason code 80, which indicates an improperly processed transaction that the cardholder does not believe they should be responsible for paying.
When to use value code 44?
Value code 44 is defined as the amount a provider agreed to accept from a primary insurer as payment in full. You may also see this referred to as "Obligated to Accept as Payment in Full, or OTAF.
What is value code 53?
claim, you must report value code FD: Code 53: Initial medical device placement provided as part of a clinical trial or free sample.
What does value code 82 mean?
Value Code 80 must be used to report covered days, which was formerly reported in Form Locator 7. Value Code 81 must be used to report non-covered days, which was formerly reported in Form Locator 8. Value Code 82 must be used to report co-insurance days, which was formerly reported in Form Locator 9.
What is value code 48 and 49?
At their August, 2005 meeting, the NUBC changed the specific definitions of Value codes 48 and 49 for the institutional bill. This change provides for the reporting of hematocrit/hemoglobin readings before the start of the billing period.
What is value code 45?
Value codes Accident hour–For inpatient claims, if the patient was admitted as the result of an accident, enter value code 45 with the time of the accident using military time (00 to 23).
What is value code 42?
Medicare requires condition code (CC) '35' - PACE eligible patient disenrolls during an inpatient admission and value code (VC) '42' - Code indicates the amount shown is that portion of a higher priority VA or PACE payment made on behalf of a Medicare beneficiary that the provider is applying to Medicare charges on ...