21-210m Check Medicare Revenue Codes on Claims

Date: 03/02/21

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Use the revenue four-digit code formats to avoid possible claim rejects

Refer to the Centers for Medicare & Medicaid Services (CMS) guidelines before you assign the Medicare revenue code on a claim.

Align with CMS guidance to use revenue four-digit codes

The claim will be accepted if a provider bills with a four-digit revenue code. Do not drop the leading zero or the claim will be rejected. For example:

• Use the Medicare revenue code 0022 to have the claim accepted. Do not use 022 or the claim includes an improper code and will be rejected.

Check the current CMS link

Reduce claim rejections and refer to current CMS guidelines to view the revenue codes.

If you receive a denial determination on a remittance advice, be sure to check CMS guidelines at the link above before assigning the applicable revenue code to resubmit it.

Additional information

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding this update, contact CalViva Health at 1-888-893-1569.