Inpatient Ancillary Services

Medicare pays for hospital (including Critical Access Hospital (CAH)) inpatient Part B services in the circumstances specified in the CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 6, Section 10. Whether or not the hospital has submitted a claim to Part A for payment, the hospital is required to submit a Part A claim indicating that the provider is liable under section 1879 of the Act for the cost of the Part A services.

The hospital must then bill Part B inpatient services on a 012X Type of Bill (TOB). Inpatient Part B services include inpatient ancillary services that do not require an outpatient status and are not strictly provided in an outpatient setting. Services that require an outpatient status and are provided only in an outpatient setting are not payable inpatient Part B services. For example: Clinic Visits, Emergency Department Visits and Observation Services (this is not an all-inclusive list).

Not Allowed When Inpatient Claim Denied for Medical Necessity

  • 010x
  • 011x
  • 012x
  • 013x
  • 014x
  • 015x
  • 016x
  • 017x
  • 018x
  • 019x
  • 020x
  • 021x
  • 022x
  • 023x
  • 029x
  • 0390
  • 0399
  • 045x
  • 050x
  • 051x
  • 052x
  • 054x
  • 055x
  • 056x
  • 057x
  • 058x
  • 059x
  • 060x
  • 0630
  • 0631
  • 0632
  • 0633
  • 0637
  • 064x
  • 065x
  • 066x
  • 067x
  • 068x
  • 072x
  • 0762
  • 082x
  • 083x
  • 084x
  • 085x
  • 088x
  • 089x
  • 0905
  • 0906
  • 0907
  • 0912
  • 0913
  • 093x
  • 0941
  • 0943
  • 0944
  • 0945
  • 0946
  • 0947
  • 0948
  • 095x
  • 0960
  • 0961
  • 0962
  • 0963
  • 0964*
  • 0969
  • 097x
  • 098x
  • 099x
  • 100x
  • 210x
  • 310x

* In the case of revenue code 0964, this is used by hospitals that have a Certified Registered Nurse Anesthetist (CRNA) exception; however, the Common Working File (CWF) will edit to ensure that Diabetic Self-Management Training (DSMT) services are not billed on a 012X TOB.

Not Allowed When Inpatient Claim Rejected Due to Beneficiary's Lack of Coverage or Services Not Covered Under Part A

  • 010x
  • 011x
  • 012x
  • 013x
  • 014x
  • 015x
  • 016x
  • 017x
  • 018x
  • 019x
  • 020x
  • 021x
  • 022x
  • 023x
  • 0250
  • 0251
  • 0252
  • 0253
  • 0256
  • 0257
  • 0258
  • 0259
  • 0261
  • 0269
  • 0270
  • 0273
  • 0277
  • 0279
  • 028x
  • 029x
  • 0360
  • 0362
  • 0367
  • 0369
  • 0370
  • 0374
  • 0379
  • 038x
  • 039x
  • 041x
  • 045x
  • 0470
  • 0472
  • 0479
  • 049x
  • 050x
  • 051x
  • 052x
  • 053x
  • 0541
  • 0542
  • 0543
  • 0544
  • 0546
  • 0547
  • 0548
  • 0549
  • 055x
  • 056x
  • 057x
  • 058x
  • 059x
  • 060x
  • 0620
  • 0623
  • 0624
  • 0630
  • 0631
  • 0632
  • 0633
  • 0637
  • 064x
  • 065x
  • 066x
  • 067x
  • 068x
  • 069x
  • 072x
  • 0760
  • 0762
  • 079x
  • 081x
  • 082x
  • 083x
  • 084x
  • 085x
  • 088x
  • 090x
  • 091x
  • 093x
  • 0940
  • 0941
  • 0942*
  • 0943
  • 0944
  • 0945
  • 0946
  • 0947
  • 0948
  • 0949
  • 095x
  • 0960
  • 0961
  • 0962
  • 0964*
  • 0969
  • 097x
  • 098x
  • 099x
  • 100x
  • 210x
  • 310x

*In the case of Revenue Code 0964, this is used by hospitals that have a CRNA.

* In the case of Revenue Code 0942, this is used by rural hospitals for kidney disease education (KDE) services. The actual geographic location, core based statistical area (CBSA) is used to identify facilities located in rural areas. In addition, KDE services are covered when claims are received from section 401 hospitals (hospitals re-designated as rural under Section 1886(d)(8)(E) of the Act). Additionally, models may allow this Revenue Code.

 

Last Updated Sep 30, 2019