What is a value code in billing?
Asked by: Mr. Garrett Schulist DDS | Last update: April 28, 2025Score: 4.1/5 (27 votes)
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 does value code 80 mean?
Value Codes: 80 – Covered days. 81 – Non-covered days. 82 – Coinsurance days.
What is the value code 24 in medical 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”. The value code will not change and will always be “24” for LTC claims.
What is value code 48 or 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 are Revenue Codes in Medical Billing?
What are value codes?
Note: The value code is the Medicaid Rate Code (MRC). The value code amount is the Designated State Level Medicaid Rate Code (DSLMRC), which identifies the type of facility that the patient resides and the level of care the patient receives.
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 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 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 is the value code 54?
For newborns, use value code 54. Code indicates the height of the patient in centimeters.
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 is value code 68?
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 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.
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 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 61?
The CBSA for the beneficiary's residence, whether or not it is an inpatient setting, is reported on the claim using value code 61. This code is currently defined by the National Uniform Billing Committee (NUBC) as “Location Where Service is Furnished (HHA and Hospice).”
What is value code 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 is the ACH code 53?
ACH Return Code R53, also known as "Item and RCK Entry Presented for Payment," is a standard code used in Automated Clearing House (ACH) transactions.
What is value code 37?
Purchased Blood and Blood Products. Hospitals that purchase blood from a blood bank or collect blood in their own blood bank and assess a charge should bill as follows: • Value code 37 and the number of pints the patient received (only when billing revenue code 0381 (packed red cells) or 0382 (whole blood)).
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 ...
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 the value code 24?
After the code conversion, these two different facility types will each have their own unique Revenue Code, Value Code 24 (Medicaid Rate Code), and Value Code 24 Amount (Designated State Level Medicaid Rate Code) combinations.
What is payment code 44?
Denial code 44 is related to a prompt-pay discount. This means that the claim has been denied because the healthcare provider has applied a discount for prompt payment, but the claim does not meet the criteria for this discount.
What is value code 23?
Medicare RA. 39 thru 41 a-d Value Codes and Amounts Patient's Share of Cost: Enter code 23 and the patient's Share of Cost for the claim. Leave blank if not applicable. Medicare Deductible: Enter code A1 if Medicare is the primary payer, or B1 if Medicare is a secondary payer.
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.