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FQHC Medicare Revenue Codes

  1. Default FQHC Medicare Revenue Codes
    Medical Coding Books
    Our practice is finally trying to figure out the revenue codes associated with each HCPCS for Medicare and I'm stuck on a couple of them. It's confusing to me since revenue codes are mainly for a hospital....If anyone has any resources or answers, I would greatly appreciate it.

    CPT 96372 injection (this one was for a B12 injection) would it be under pharmacy....professional fees???

    CPT codes 20553 (injection trigger point) and 11055 (trim skin lesions) What revenue code goes with in-office procedures?

    Also, I heard the first line item (with the rev code 0521) should be the office visit but that it should be for the sum of all of the charges for the day. So...for example, if we billed a 99213 for $105 and a 36415 for $5, would I list it as 99213 for $110.00 and then the 36415 for $5? From the info I got, the first line item is the one that determines the co-insurance and that's why you want the total charges on the office visit but that just seems weird.

    Any help would be greatly appreciated. I'm pretty new to this FQHC billing and it is a nightmare.

  2. #2
    Fayetteville, NC
    Default Revenue Codes
    I've been working for an FQHC facility for many years. Here are the revenue codes we use:
    96372-Revenue Code 0761 Treatment room
    In Office Procedures- Revenue Code 0761 Treatment room
    Any J codes and Vaccines- Revenue Code 0636 Drugs requiring detailed coding
    90471/90472- Revenue Code 0771 Vaccine administration
    It is important to note that the codes for Influenza, Pneumococcal and Hepatitis B change, revenue codes stay the same.
    Influenza: Q2037 for the vaccine, G0008 for the administration
    Pneumococcal: G0009 for the administration
    Hepatitis B: G0010 for the administration

    All charges, with the exception of Influenza, Pneumococcal and Hepatis B, are bundled into revenue code 0521. Using your example, with a 99213 of $105 and 36415 of $5.00, what you would bill to Medicare is 99213 of $110 and 36415 of $5.00. Medicare will pay the office visit and deny all other charges for global/bundled services.
    *Whenever you bill a service with Influenza, Pneumococcal or Hepatitis B, be sure to add condition code A6. Medicare will pay those services 100% in the cost report.

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