Revenue Code 206: General Inpatient Routine Charges

In hospital billing, a revenue code is a three or four-digit number used to categorize charges on a claim form. These codes are entered on a standardized form, most commonly the UB-04, which is submitted to payers like Medicare, Medicaid, and private insurance companies. The codes tell the payer what type of service or accommodation a patient received.

There is no single revenue code that summarizes all general inpatient routine services. Instead, these charges are billed using a combination of codes that specify the type of accommodation. The most common codes for routine room and board are in the 011x to 015x series; for example, the 012x series is used for a semi-private two-bed room. These codes signify the standard, non-specialized care a patient receives while admitted to a facility.

Services Covered by General Inpatient Routine Charges

The revenue codes for general inpatient care bundle the services and accommodations provided to a patient during a hospital stay. The primary component of this charge is room and board, which covers the cost of a semi-private room. This charge encompasses the physical space, utilities, and general maintenance of the patient’s living area.

Another service included under these revenue codes is routine nursing care. This involves services provided by the hospital’s nursing staff that are not considered specialized or intensive. Examples include monitoring vital signs, administering medications as prescribed, and assisting with daily activities like bathing and mobility.

Meals and nutritional services are also part of the bundled charge. This includes standard meals, dietary consultations, and any necessary adjustments to the patient’s diet based on their medical condition. The cost covers food preparation, delivery, and the professional oversight of the hospital’s dietary staff.

Common Exclusions and Separate Charges

While room and board codes cover routine services, many other hospital charges are excluded and billed separately using different revenue codes. These ancillary services are supplemental to routine care and are specialized diagnostic or therapeutic services ordered by a physician to treat a patient’s condition.

Common separately billed charges include:

• Pharmacy charges for medications administered to the patient, which are itemized under the 025x and 063x revenue code series.
• Laboratory services required for diagnosis, like blood tests or urinalysis, billed under the 030x and 031x revenue code series.
• Procedural services, such as the use of an operating room (billed under the 036x series) and any related anesthesia services.
• Professional fees for physicians, including surgeons and specialists, which are not part of the hospital’s facility charges and are billed separately.

How Charges Are Calculated and Billed

The calculation method for general inpatient charges is based on a “per diem” or daily rate. This means the hospital establishes a flat fee, dictated by its chargemaster, that is charged for each day a patient is admitted as an inpatient. This per diem rate covers the bundled routine services, including the semi-private room, nursing care, and meals for a 24-hour period.

When a bill is prepared, the hospital multiplies this daily rate by the number of days the patient was in a general inpatient setting. This total amount is then entered on the claim form next to the appropriate room and board revenue code. For example, if a hospital’s per diem rate for general inpatient care is $2,000 and a patient stays for three days, the claim will show a $6,000 charge.

This per diem charge is submitted to the patient’s insurance payer for reimbursement. For many payers, including Medicare, reimbursement is determined by a Diagnosis-Related Group (DRG) system. Under a DRG model, the hospital receives a single, predetermined payment for the patient’s entire admission based on their diagnosis. The per diem charge from the room and board code becomes one component of the total charges used in this broader payment calculation.