Getting paid on time can depend on the right use of all the revenue codes by health care workers.
One of the big mistakes that health care workers make with revenue codes is how they use the code 0118. This code is for rehab services in a private room. It’s really important to know when and how to use this code right. This helps avoid delays in billing or getting paid wrong for these services.
We want to help you get your reimbursements back on time and stop billing mistakes. We cover Revenue Code 0118, which means we’ll explain how to use it, what it is, how much you get reimbursed from this code, and how to bill for it.
What is Revenue Code 0118 in Medical Billing?
Revenue Code 0118 is used to charge for the room and board at an inpatient rehabilitation facility when the patient is housed in a private room. The 0118 code is a signal to the payer that the patient was admitted to a rehab unit and that he/she had their own private room, but it does not indicate what type of physical therapy, occupational therapy or speech therapy the patient received during the course of his/her stay. That information will be coded and charged separately.
Note: If the patient is housed in a semi-private room for inpatient rehabilitation, then the appropriate code is 0128, not 0118.
What Revenue Code 0118 Represents and Does Not Represent
Revenue Code 0118 represents only the room and board that were provided for an inpatient rehabilitation stay. Therefore, when you submit this code to the payer, you are simply stating that the patient was admitted to an inpatient rehabilitation unit and that the facility provided the room and basic daily care during the patient’s stay.
The 0118 code does not represent any of the rehabilitation therapies that were provided to the patient. The actual rehabilitation therapies provided to the patient will be submitted as separate charges. Examples of how the rehabilitation therapies would be billed separately from the 0118 code follow:
- Physical Therapy (PT) is billed under the 042x series of codes
- Occupational Therapy (OT) is billed under the 043x series of codes
- Speech-Language Pathology (SLP) is billed under the 044x series of codes
Therefore, the 0118 code is a way to inform the payer of where the patient resided during their rehabilitation stay, while the therapy codes will inform the payer of the type of care the patient received during their stay.
Who Uses The 0118 Revenue Code
Revenue code 0118 is submitted by a healthcare facility/institute, rather than by an individual healthcare provider or physician. As a result, when hospitals or inpatient rehabilitation units submit the UB-04 facility claim, they will list the 0118 code to show that the patient occupied a private room during their rehabilitation stay. However, individual clinicians, such as therapists, doctors or social workers do not submit the 0118 code as part of their professional claims.
When inpatient rehabilitation stays occur, many types of healthcare professionals provide care to the patient as a team, including:
- Physical Therapists
- Occupational Therapists
- Speech-Language Pathologists
- Rehabilitation Nurses
- Physiatrists (Rehab Physicians)
- Rehab Techs or Assistants
- Neuropsychologists
- Psychiatrists
- Social Workers
- Case Managers
While each member of the team contributes to the patient’s recovery, only the facility submits the room and board charge using the 0118 code.
How Do I Know When To Use Revenue Code 0118?
You will know whether to use the 0118 revenue code when the patient meets the following criteria:
- The patient is admitted to an inpatient rehabilitation unit or inpatient rehabilitation facility.
- The patient is housed in a private room.
- The patient is receiving a team-based rehab program as part of their treatment plan.
Example:
A patient undergoes a knee replacement and comes to your inpatient rehab unit. During their stay, the patient receives both physical and occupational therapy daily, and is housed in a private room. In this case, the facility will submit the 0118 code to cover the room and board for the patient, and the therapy services will be submitted separately using their respective therapy revenue codes and CPT/HCPCS codes.
Other Situations Where Revenue Code 0118 Is Not Applicable
There are several different scenarios in which you would not want to use the 0118 code. Some examples of these situations are listed below:
➜ The patient is not in inpatient rehabilitation.
For example, they are just staying on a regular hospital medical or surgical floor.
➜ The patient is in a semi-private / shared room.
In those cases where the patient is sharing a room with one or more other patients, the semiprivate version of the inpatient rehab code is used, which is the 0128 code.
➜ The patient is receiving outpatient rehabilitation.
The codes and billing requirements for outpatient rehabilitation differ significantly from those for inpatient rehabilitation. Therefore, inpatient rehabilitation codes cannot be used for outpatient rehabilitation services.
➜ The patient is having only a single therapy session, i.e., only PT, only OT or only SLP.
In cases where the patient is being seen solely for a specific type of therapy, the appropriate therapy revenue code family (042x, 043x, 044x) is used along with the corresponding CPT or HCPCS code(s).
We Make Sure Your Facility Gets Paid for Every Rehab Day
A lot of facilities fail getting paid for private room rehab stays. BellMedEx Medical Billing Services makes sure Revenue Code 0118 is billed right, so your business gets paid for each day the patient stayed. Every day, we monitor, verify eligibility, and avoid income loss for hospitals.
Revenue Code 0118 Reimbursement Rates (Fee Schedule)
The amounts of reimbursement for the inpatient rehabilitation services using RC 0118 will vary based upon who is paying for the service (payer), what has been agreed to within the contract between the healthcare facility and the payer, and whether there have been other inpatient rehabilitation services provided to the patient.
Therefore, this information below contains estimated, average daily amounts of reimbursement for inpatient rehabilitation services utilizing revenue code 0118, but these estimates are subject to change due to the specifics of the contracts between the healthcare entity and the payers:
- Blue Cross Blue Shield (BCBS) = $327.72/day
- UnitedHealthcare (UHC) = $12,370.95/day
- Aetna = $2,239.20/day
- Cigna = $19,854.55/day
These above listed amounts should be used as references when determining the amount of reimbursement for inpatient rehabilitation services using 0118 revenue code.
It’s important to understand that 0118 revenue code only accounts for the cost of room and board for the duration of the inpatient rehabilitation stay. Therefore, the amount of reimbursement you actually receive will depend on many things, including:
- The terms of your contract with each payer.
- The payer-specific fee schedule(s) utilized by each payer and how they define “per diem” or other reimbursement methodologies.
- If the patient is enrolled in Medicare, or if they are enrolled in a commercial insurance program. Medicare uses an entirely different method for paying for inpatient rehabilitation services, such as the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS).
To get the most accurate estimate of your potential reimbursement, please refer to your contract with your payer, or the price transparency file for your hospital.
Step-by-Step Billing Process for Revenue Code 0118 in Medical Billing
Whether you’re a rehab facility or an inpatient unit within a hospital, following a clear and precise process ensures that you capture the full reimbursement for the care provided in a private room during inpatient rehabilitation.
We’ll walk you through the exact steps to properly bill for Revenue Code 0118, from verifying the patient’s eligibility to submitting the claim. Let’s break it down to ensure every detail is covered and your practice receives accurate and timely payment.
Step 1: Confirm the Patient’s Insurance Benefits Prior to their Admission
Before admitting a patient to inpatient rehab, it is essential to confirm the patient’s insurance coverage. By confirming this prior to their admission, potential surprises down the road can be avoided (like a claim denial or the patient being billed out-of-pocket because the stay wasn’t authorized or wasn’t covered by their plan).
Take a moment to verify:
- Is inpatient rehab included within the patient’s plan benefits?
- Does your facility have an agreement (in-network) with the patient’s insurance provider?
- Are pre-authorizations necessary? If so, obtain them.
- Are there limits to the number of inpatient rehab days that are covered?
Step 2: Complete the UB-04 Form Accurately
When billing for an inpatient rehab stay, room and board costs will be entered onto the UB-04 claim form.
Complete the following fields:
- Revenue Code (Field 42): Enter 0118 to indicate that the patient was in a private room while receiving inpatient rehab.
- Service Units (Field 46): Enter the number of days the patient spent in the hospital.
- Total Charges (Field 47): Multiply the daily private room rate by the number of days and enter the total amount due.
⭐ Counting the Number of Days (the Midnight Rule)
While counting the days may seem a bit complicated, there is a simple way to think about it:
If the patient has not been discharged at midnight, then the day counts. The discharge date rarely counts unless the patient was present in the hospital past midnight into that morning.
For example:
A patient is admitted to the hospital on a Monday and discharged early Friday morning: Since the patient was in the hospital at midnight on Monday, Tuesday, Wednesday and Thursday, you would bill 4 days. Friday is not billed since the patient did not spend the night into Friday.
Step 3: Ensure Documentation Validates the Need for Inpatient Rehab Services
Payers require documentation that supports why the patient was able to receive inpatient rehab services rather than receiving outpatient therapy or home health services. The documentation (medical necessity document) should demonstrate the level of supervision and coordination of services the patient required.
To document the medical necessity for inpatient rehabilitation, the documentation should include:
➜ Reason for admission: Explain why the patient needed inpatient rehabilitation and could not safely or effectively recover in a less intensive setting.
➜ Interdisciplinary treatment plan: Identify the various treatments and services that will be used (for example PT, OT, speech therapy), and explain how they will work together to assist in the patient’s recovery.
➜ Daily progress notes: Document how the patient progressed each day, any changes in their ability to perform tasks, and any updates to their treatment plan.
➜ Discharge planning: Explain how the patient will be prepared for discharge, and what types of care or support will be available to them after discharge.
Documentation that supports the quality of the care provided will also help to reduce the risk of claim denial or delay.
Step 4: Know Which Services Are Billed Separately
Revenue code 0118 only includes the cost of room and board for the patient during their inpatient rehabilitation stay. Revenue code 0118 does not include the rehabilitation therapy services themselves.
The therapies provided during the inpatient rehabilitation stay are billed on the same UB-04 claim form; however, they are identified by different revenue code families, along with the appropriate CPT or HCPCS codes:
- Physical Therapy: 042x
- Occupational Therapy: 043x
- Speech-Language Pathology: 044x
Physician services (such as visits from the physiatrist) are generally billed on a CMS-1500 claim form by the physician or their practice, not under 0118.
Additionally, if the services were delivered via telehealth, review the payer’s requirements for telehealth billing, including any required modifiers and revenue codes that differ from other services.
Step 5: Review the Claim and Submit It
Before submitting the claim, review all information to ensure accuracy. Accuracy will help to minimize rework and delays.
Verify the following:
- All required fields on the UB-04 are completed accurately
- Units, charges, and revenue codes are accurate and reflect the patient’s documentation in the chart
- Authorization number (if required) is included in the claim
- Documentation provides evidence of the medical necessity for inpatient rehabilitation and the duration of the stay
Upon verifying that all the above criteria are met, submit the claim via electronic transmission or paper submission, depending upon the payer’s preference.
Capture Full Reimbursement for 0118 Room and Board
Room and board in Revenue Code 0118 need to match the therapy bills. BellMedEx helps with medical billing. We make sure PT, OT, and speech therapy codes match the rehab stay, which helps get claims accepted.
