In medical billing, revenue codes tell payers about what you are billing. Revenue code 0111 is the line you will bill for a private 1 room bed in a general medical, surgical, or obstetrical unit. Getting this right is critically important because your decision on the revenue code affects approval, timing of payment, and cash flow.
In this guide we explain what 0111 covers, how to document medical necessity, how to count units by calendar days, how to place it correctly on the UB 04, and how Medicare, Medicaid, and commercial plans typically pay for it.
What is Revenue Code 0111 in Medical Billing?
Revenue code 0111 is used when a patient is in a private room on a general medical, surgical, or gynecology floor. It represents the daily room and board charge for that single-bed room.
This code doesn’t just include the physical space when a patient is in a private room. It also includes the routine ancillary services related to the room, such as the nursing care, meals, linens, etc., as well as housekeeping. That is, the “hotel” aspect of the hospital stay bundled with the basic ancillary care a patient receives day in and day out.
It’s important to note that revenue code 0111 is only for private rooms in these general units. There are other specialized types of inpatient areas such as ICU, NICU, psychiatric, or rehab units that are billed with different revenue codes.
As a comparison point, if a patient is placed in a semi-private two-bed room on the same type of floor, the hospital would use revenue code 0121 instead.
Why is revenue code 0121 used for a semi-private room instead of 0111?
➜ 0111= Private room (one bed). Since a patient has this room to themselves, there is a higher charge related to this code.
➜ 0121= Semi-private room (two beds). This code is used when the patient is in a shared room with one other patient. The cost of care for the hospital is lower where there are two patients that share a room (shared space, shared resources), so the reimbursement is lower.
When a hospital bills for an inpatient stay, the hospital will use revenue code 0111 in the UB-04 claim form to denote the individual daily charge for the private room portion of care.
How to Use Revenue Code 0111 for Billing?
Using Revenue Code 0111 correctly isn’t just about slapping it on a claim and hoping for the best. There are a few key steps that ensure you’re doing it right and getting reimbursed for the correct services.
1). Verify the need for a private room.
Most payers treat a semi private room as the default. A private room is covered when the chart shows a clear clinical reason. So before you use revenue code 0111, make sure the record explains why the patient cannot safely be in a shared room.
Here are some common, defensible reasons that can be mentioned in the record:
➜ Infectious isolation.
There are numerous examples including TB, COVID 19, influenza, or any other contagious condition. There is often an isolation order and evidence in the note that the patient requires separation.
➜ Protective isolation.
Some patients are severely immunocompromised (i.e. neutropenia, recent transplants etc.) and require a private room, meaning there is a reduced risk of transmitting infection.
➜ Safety or close monitoring needs that do not work in a shared room.
For example, behavior which puts the patient or others at risk, frequency of intervention which would upset another patient, or use of specific equipment which cannot be effectively shared.
What to document in the clinical record?
- Provider order specifying a private room, isolation, or protection, with clinical rationale.
- A diagnosis or problem list which supports the rationale justification.
- Nursing and infection control documentation that shows the precautions in use.
- Dates and times. Bill 0111 only for what is considered days spent in an active private room location.
Note: Patient preference alone does not justify!
If the sole basis for private accommodation is patient preference, most payers will not cover the extra cost. Document the request and any conversations related to potential out of pocket costs. If the payer has determined there is not an adequate medical condition warranting the semi private pay rate, then follow that rule.
2). Determine the correct dates and duration.
Once you know the private room is medically needed, pin down the exact dates the patient was in that private room. For room and board, you bill by calendar days, not by 24 hour blocks.
Think in midnights. Each unit is one calendar day that the patient occupied the private room at midnight. The day of discharge is usually not billed as a room and board day. If admission and discharge happen on the same calendar day, you typically bill one unit.
Here’s how to set the dates:
➜ Start date is the first calendar day the patient is actually in the private room with a supporting order.
➜ End date is the last calendar day before the patient leaves the private room, transfers to another level of care, or is discharged.
Examples
Admitted to a private room on March 1 and discharged on March 3. The patient was in the private room at midnight twice, so bill 2 units of 0111 for March 1 and March 2.
Moved from a private room to a semi private room on March 2 at 3 pm. If the patient is in the semi private room at the midnight that begins March 3, bill 0111 for March 1 only, then use the semi private room code for the days after the move.
Note: If the patient spends any day in ICU, NICU, psych, or rehab, use those unit revenue codes for that day. Switch back to 0111 only when the patient returns to the private room on a general unit.
3). Enter revenue code 0111 details on the UB-04 form.
Now that you have the dates and units established, you can complete the private room charges on the claim. This is the information you will enter on the UB-04 form’s fields for the room and board line item:
- FL 42 Revenue Code: 0111
- FL 43 Description: write “Room and Board Private”
- FL 46 Service Units: the number of covered private room days you counted in Step 2
- FL 47 Total Charges: your private room daily rate multiplied by the units (for example, $200 x 4 private room days = $800 total charges for room and board private)
- FL 44 HCPCS/Rates: Leave this blank unless specifically requested by the payer to include a code.
When you’re filling out your UB-04, also make sure that the remainder of the claim aligns with your room and board entry.
✅ FL 6 Statement Covers Period should demonstrate the admission and discharge dates that you are billing the private room days for (for example if the patient was admitted, changed to a private room and discharged from there, the dates on the claim will show all days from admission to discharge).
✅ Diagnosis codes must be ICD-10-CM. Be sure to include the principal diagnosis and if, for example, the private room was because of an active infection that was isolatable, be sure the diagnosis clearly indicates that.
✅ Procedure codes will depend on the type of claim being filed. For inpatient facility claims, use ICD-10-PCS when a procedure code is needed. CPT and HCPCS codes are reserved for outpatient or professional billing, not for inpatient facility procedures.
Note: If a patient simply chooses a private room but there is no medical reason (like isolation or safety), most insurance companies and Medicare will only pay what they would have paid if the patient were in a semi-private room. That’s called paying the semi-private rate.
The extra charge above the semi-private rate is considered non-covered by the payer. On the UB-04 claim, that part should be shown in the field for non-covered charges (FL 48). This makes it clear that you are not asking the insurer to pay for it.
Since insurance won’t pay the difference, hospitals usually follow their own financial policy:
- Notify the patient (or family) that insurance only covers the semi-private amount.
- Bill the patient directly for the extra cost of the private room if they agreed to it as a personal choice.
- Sometimes the hospital may absorb the cost if the private room was assigned because no semi-private beds were available. In that case, the patient should not be billed the difference.
4). Double check medical necessity
Before you submit the claim with revenue code 0111, take a moment to verify that the chart indicates that a private room was medically necessary for the patient. Most payers assume a patient will be in a semi-private room, so your documentation should make the clinical need easy to recognize.
What your documentation should show:
- A provider order specifying a private room or isolation, with the reason spelled out.
- The clinical context associated with the need for privacy or separation, like infection isolation, protective isolation for an immunocompromised patient, behavioral or safety concerns, or frequent interventions, which would not be able to occur in a semi-private space.
- Supporting diagnoses on the problem list that are aligned with whatever reason you wrote in the order and notes.
- Start and stop dates for the private room, so the billed units line up with the record.
5). Give the claim one last check
Before you hit submit, take a final look to be sure everything lines up. Ask yourself:
➜ Do the units you’re billing match the number of midnights the patient actually spent in the private room?
➜ If the patient moved between units, did you switch to the correct revenue codes for each part of the stay?
➜ Does the total charge equal the daily rate multiplied by the units?
➜ Do the admission and discharge dates, the patient status code, and the type of bill all make sense together?
This quick pass can save you the headache of denials and rebills later.
6). Watch what happens after you submit
After submitting the claim, watch the remittance advice (RA). The RA will tell you what the payer did with your charges.
If the amounts were cut down to the semi-private rate, verify if that was the payer’s policy for the patient. Sometimes this is to be expected, especially in the absence of medically necessary criteria for private rooms.
If the claim is rejected for medical necessity, do not despair! Send in an appeal with the isolation order, daily progress notes, and a brief statement tying the diagnosis to the need for private room status.
If the patient was in a private room only because no semi-private beds were available, document that clearly. Even though many payers will limit payment to the semi-private rate, the patient should not have to pay the difference because they did not chose to occupy a private room.
Medical Billing Reimbursement Rates for the 0111 Revenue Code
Each insurance payer reimburses room and board slightly different from the others. Revenue code 0111 tells the payer “this patient was in a private room on the general medical, surgical, or gynecology floor,” but the code itself typically does not dictate payment. How much you actually receive is based on the payer’s method of payment and your hospital’s contract with that payer.
Medicare (traditional)
Medicare pays inpatient hospitals using MS-DRG (Medicare Severity Diagnosis-Related Groups). A DRG is like a “package deal.” Instead of paying for each service line by line, Medicare groups the stay into one all-inclusive payment based on the patient’s diagnoses, procedures, and overall condition.
Room and board charges (including 0111) are part of that package deal. You will not receive a separate payment for the 0111 line.
So, why report it? Because your charges still matter for Medicare’s cost calculations, outlier payments, and audits. Always report correct units and charges even though the DRG drives the actual reimbursement.
Medicaid
Medicaid programs vary widely from state to state. The DRG system is used by some states and Medicaid managed care plans while others continue to utilize per diem rates (based on bed type) for inpatient costs.
Some states reimburse less for room and board than others and some states provide small adjustments for services such as critical access hospitals.
Whether you will be reimbursed for the private room rate or the semi-private room rate depends on specific state rules and regulations.
Example: In one state, Medicaid may pay $500 for a semi-private room rate per day or $650 for a private room rate (for medically necessary private room). In another state, the payment is bundled in the same way as Medicare payments and covered by a DRG. Always check your state’s schedule.
Private commercial payers
Private insurers are the most variable. They don’t follow a single model.
- Some pay per diem rates: for example, $1,200 per day for semi-private and $1,500 for private.
- Others use DRGs or case rates, similar to Medicare.
- Some base reimbursement on a percent of charges, with caps or stop-loss rules if charges get very high.
- Increasingly, private commercial payers are utilizing bundled payment methods where the room and board is only one aspect of a negotiated total for the patients hospitalization.
Here are the average reimbursement rates by major private insurers:
| Insurance Company | Reimbursement for RC 0111 |
| Blue Cross Blue Shield (BCBS) | $642.36 |
| United Healthcare (UHC) | $5,191.33 |
| Aetna | $13,821.12 |
| Cigna | $26,884.72 |
Note: Keep in mind the dollar figures are only ballpark estimates. Commercial payment for 0111 is contract-driven and will differ by hospital, insurer, and geographic region.
Almost all private insurers have a clause in their contracts that states: if the private room is only for preference, then they will only pay the semi-private room rate. This is why your documentation is so important if you want to be reimbursed at the higher private room rate.
Example: Blue Cross may agree to pay $1,400 per day for a private room rate room under your contract, but only if the medical record evidences isolation precautions. If the patient just wanted privacy, Blue Cross will pay $1,000 which is the semi-private room rate, and your organization can either absorb the difference or bill the patient (if that is your policy and the patient was notified).
FAQs
1). What services are included with RC 0111?
The daily room charge plus routine inpatient services that come with the room. Think nursing care, meals, linens, and housekeeping.
2). Does 0111 apply to ICU, NICU, psych, rehab, or labor and delivery?
No. Specialty units use their own revenue codes. Use 0111 only for private rooms on general medical, surgical, or gynecology floors.
3). Can I bill 0111 revenue code during observation?
No. Observation is outpatient. Use the observation revenue code for those hours. Start 0111 on the first inpatient calendar day in the private room after a valid inpatient order.
4). What documentation do I need for a private room?
A provider order that states private room or isolation with the clinical reason, notes that support the need each day, any infection control precautions, and start and stop dates that match the units.
5). Is patient preference enough to get the private room rate?
Usually not. Most payers default to the semi private rate if there is no medical necessity. If the room was assigned for preference only, list the extra amount as non covered and follow your financial policy.
6). What if no semi private beds were available?
Document that clearly. Many payers still limit payment to the semi private rate, but the patient should not be billed the difference when it was not their choice.
7). How do I put revenue code 0111 on the UB 04?
- FL 42 Revenue Code: 0111.
- FL 43 Description: Room and Board Private.
- FL 46 Service Units: number of covered private room days.
- FL 47 Total Charges: daily rate times units.
- FL 44 HCPCS: usually blank unless the payer requires it.
Also make sure FL 6 Statement Covers Period matches the days you billed.
8). Which diagnosis and procedure codes go with 0111?
Diagnosis codes use ICD 10 CM. Procedures for inpatient facility claims use ICD 10 PCS when needed. CPT and HCPCS codes are for outpatient or professional claims, not inpatient facility procedures.
9). What are common reasons a claim gets reduced or denied?
No clear medical necessity documented, units do not match midnights, wrong revenue code after a unit transfer, or inconsistent dates between the claim and the chart.
10). How do I appeal a denial for medical necessity?
Send the private room or isolation order, daily progress notes, infection control notes if relevant, and a short summary that ties the diagnosis to the need for a private room on the dates billed.
11). Can I bill the admission day as a unit if admission and discharge are the same day?
Typically yes, that is one unit, as long as the patient was admitted as an inpatient and occupied the private room that day. Check payer rules.
12). How do I count units for 0111?
A unit simply means one day charged for the private room. You don’t count hours. Instead, look at where the patient is at midnight:
- If the patient is still in the private room at midnight, that counts as 1 unit.
- You add up each midnight the patient spends in that private room.
- The discharge day usually does not count as a unit, unless your payer has a special rule.
Example:
A patient is admitted to a private room on June 5 in the afternoon and discharged on June 7 in the morning.
- Midnight of June 6 = patient is still in the private room → 1 unit
- Midnight of June 7 = patient is still in the private room → 2 units
- Discharge on June 7 morning does not add another unit.
So the bill is 2 units of 0111.
