What Is Revenue Code 921 for Individual Accommodations?
Learn how billing codes distinguish between private rooms for medical need versus patient comfort and the impact this has on claim forms and reimbursement.
Healthcare facilities use a standardized system of numeric revenue codes to categorize services for billing. These codes allow hospitals to communicate with payers, like insurance companies, about the specific accommodations or procedures a patient received. This system ensures a uniform understanding of charges across the industry.
Scope of Individual Accommodations
Revenue Code 921 is designated for “Individual Accommodations,” which refers to a private room occupied by a single patient. This code is used when the private room is provided for the patient’s personal comfort or convenience rather than out of medical necessity. For instance, a patient might request a private room for additional privacy, and the facility would use this code to bill for the accommodation.
The use of Revenue Code 921 is distinct from situations where a private room is medically required, such as for infection control, which would use different codes. Revenue Code 921 signals to the payer that the charge is for a patient-preference item, not a service dictated by the patient’s clinical condition. The code itself only describes the room type and its non-medical justification, not the level of medical care administered.
This code isolates the charge for the room itself from other billable services. The daily rate for an individual accommodation is captured under this code, separate from charges for medications, physician services, or diagnostic tests. This distinction helps with billing transparency and insurance adjudication.
Usage on Claim Forms
When a hospital bills for a private room provided for convenience, Revenue Code 921 is entered as a line item on the UB-04 claim form. This form, or its electronic equivalent, the 837I transaction, details all services rendered during a patient’s stay. The line item will include the 921 code, the total number of days the private room was used (listed as units), and the total charge.
This code is part of a larger system where different number series represent various types of accommodations. For example, codes in the 012x series are typically used for semi-private rooms, the standard accommodation covered by most insurance plans. Using 921 distinguishes the charge from these more common room types or from higher-acuity accommodations like intensive care units, which have their own unique revenue codes.
The final reimbursement for charges billed under Revenue Code 921 depends on the patient’s insurance plan. Since the code identifies the service as not medically necessary, many insurance carriers will not cover the cost, or will only cover the amount equivalent to a semi-private room. Consequently, the financial responsibility for the difference in cost often falls to the patient.