Revenue Codes 905, 906 and 0126 on the UB-04

What a revenue code does on a UB-04

The UB-04 is also called the CMS-1450. CMS is the Centers for Medicare & Medicaid Services. The form is the standard paper claim form that institutional providers use. That means facilities, as opposed to individual practitioners. Each UB-04 line carries a revenue code.

A revenue code has four digits. Each one carries a service description. Some codes name a service, such as 0915 for group therapy. Others name a room, such as 0126 for detoxification in a semi-private room.

A revenue code often travels with an HCPCS code on the same line. HCPCS stands for the Healthcare Common Procedure Coding System. An HCPCS code defines the service or procedure performed.

Professionals bill on the CMS-1500, the standard paper claim form for professional claims. The 837P is the standard electronic format for them. The 837I is the electronic institutional transaction.

Each code in this guide comes from a Medicare contractor's list, a CMS manual or a payer's own published policy.

The 090X series: IOP, PHP and day treatment

Noridian puts behavioral health treatments and services under 090X on its revenue code list and extends the group into 091X. Two programs sit behind the codes that follow: the intensive outpatient program (IOP) and the partial hospitalization program (PHP). Medicare describes IOP as less intense than a PHP.

The group opens with 0900, the general behavioral health line. In 2004 CMS stopped the use of 0910 for Medicare. It told hospital outpatient departments, community mental health centers (CMHCs) and critical access hospitals to report psychiatric and psychological partial hospitalization services under 0900. Rural health clinics and FQHCs report mental health services under 0900 and do not report IOP there.

Revenue code 0905

Indiana's Medicaid module describes 905 in nearly the same words as Noridian's list.

Evernorth lists mental health IOP as revenue code 905 with preferred HCPCS S9480 on a UB form. Magellan wants 0905 on the UB-04 and S9480 on the CMS-1500.

Medicare is where 0905 gets tangled. The claims manual's accepted revenue code tables for hospital and CMHC IOP do not list 0905. Its worked examples for those claims use 0905 anyway. Noridian's IOP page does the same, with 0905 missing from its code tables and present in its hospital example. Rural health clinics and FQHCs report IOP with revenue code 0905 and condition code 92, the short code that identifies an IOP claim.

Revenue code 0906

Noridian's list describes 0906 as chemical dependency. Its IOP page marks the 0906 row OTP, short for opioid treatment program. Neighborhood Health Plan of Rhode Island pairs 0906 with H0015. Iowa Medicaid names 0906 with H0015 for facility-based IOP. Indiana treats 906 like 905, with no procedure code and a flat rate a day. Noridian lists 0907 as the community behavioral health program, day treatment.

Revenue codes 0912 and 0913

Noridian lists 0912 as partial hospitalization, less intensive, and 0913 as partial hospitalization, intensive. Blue Cross NC's commercial policy puts 0912 at three to five hours and 0913 at six or more. Blue Cross Blue Shield of Michigan puts 0913 at 21 or more hours a week and 0912 at 20 or fewer. So the two terms mean different hours at different payers. Medicare sets its PHP floor at 20 hours of services a week and its IOP floor at 9.

Medicare's accepted revenue code lists for PHP do not include 0912 or 0913. Medicare builds a PHP claim from components, a revenue code and a charge for each covered service.

ASAM, the American Society of Addiction Medicine, calls Level 2.5 High Intensity Outpatient. Optum's July 2025 notice moves adult commercial substance use partial hospitalization, ASAM Level 2.5, from revenue code 912 or 913 to 907. The move waits for a fully executed, updated contract. Until then Optum says to keep following the 3rd Edition guidelines for adult commercial PHP.

The rest of 091X on Noridian's list runs 0911 rehabilitation, 0914 individual therapy, 0915 group therapy, 0916 family therapy, 0917 biofeedback, 0918 testing and 0919 behavioral health treatments. The list has no 0910 line.

Room and board: the psychiatric and detox accommodation lines

An accommodation code is a room-and-board code. On Noridian's list, each room type has its own family, and each family has a psychiatric line and a detoxification line.

011X, private, one bed: 0114 psychiatric and 0116 detoxification.
012X, semi-private, two beds: 0124 psychiatric and 0126 detoxification.
013X, three and four beds: 0134 psychiatric and 0136 detoxification.
014X, deluxe private: 0144 psychiatric and 0146 detoxification.
015X, ward: 0154 psychiatric and 0156 detoxification.

Revenue code 0126

0126 is detoxification in a semi-private room with two beds. Blue Cross and Blue Shield of Mississippi bills acute medical detox in a residential treatment center on type of bill 086X. The type of bill is the code for the kind of facility billing. It uses 0116, 0126, 0136 or 0146. It reports the units as days. It leaves 0156 off that list. It says not to count the discharge day.

For Direct, Together and One Care, Tufts Health Plan lists inpatient Level 4 detox as 0116, 0126, 0136 and 0156. It counts one unit a day and takes the claim on a UB-04. It calls inpatient substance use detox on 0116 and 0126 an all-inclusive per diem. A per diem is a flat daily rate that bundles everything delivered at that level of care that day. Washington's Medicaid guide bills non-secure withdrawal management, which is detox care, in a behavioral health hospital under 0126 on the institutional claim.

1001 and 1002: residential treatment

Noridian's list puts residential treatment in the 100X behavioral health accommodations. It shows 1001 as residential treatment, psychiatric, and 1002 as residential treatment, chemical dependency.

Blue Cross and Blue Shield of Mississippi uses both on type of bill 086X and reports the units as days. It keeps residential treatment on 1001 or 1002 apart from acute medical detox on 0116, 0126, 0136 or 0146. It rejects claims that do not follow its guidelines.

1002 does not always mean residential treatment. In the Tufts table for Direct, Together and One Care, Acute Treatment Services Level 3.7 is 1002 plus H0011. That pair is acute detoxification in a residential addiction program. Level 3.5 is 1002 plus H0010, which is subacute detoxification. Washington bills secure withdrawal management on 1002 with bill type 86X.

Other payers use other codes. New Mexico bills adult accredited residential treatment centers on a UB claim form with revenue code 1003. The H code follows the tier: H0019 for Tier 1, ASAM Level 3.1, and H0018 for Tier 2, Levels 3.3 and 3.5. Nevada Medicaid bills youth psychiatric residential days under 0100 and therapeutic leave days under 0183. Nevada's all-inclusive daily rate includes room and board.

The codes that travel with them: HCPCS, condition codes and type of bill

S9480 is intensive outpatient psychiatric services, per diem. H0015 is alcohol and drug intensive outpatient. H0035 is mental health partial hospitalization, less than 24 hours. CMS says private insurers use S codes primarily. Medicaid programs may use them, but Medicare does not pay them.

A condition code is a short code in a set field of the UB-04. Condition codes go in form locators 18 to 28, the numbered fields on the form. Condition code 41 marks partial hospitalization. Hospitals, critical access hospitals and CMHCs report it on Medicare PHP claims. Condition code 92 marks IOP. Hospitals and CMHCs must use it on every Medicare IOP claim. Rural health clinics and FQHCs use it too. Medicare returns an IOP claim to the provider when it overlaps a PHP claim.

The type of bill names the kind of facility. For Medicare IOP, hospitals use 013X, critical access hospitals use 085X and CMHCs use 076X. Rural health clinics use 71X and FQHCs use 77X. For Medicare PHP the bill types are 13X, 85X and 76X.

How payers pair them, with examples

The table sets out pairs from published payer policies.

Payer	Revenue code	HCPCS code	Form, unit or setting
Evernorth	905, mental health IOP	S9480, preferred	UB form
Magellan	0905 or 0906	S9480 for psychiatric IOP, H0015 for alcohol and drug IOP	Revenue codes on the UB-04, HCPCS codes on the CMS-1500
Indiana Medicaid	905	None allowed on that line	Institutional claim, flat rate a day. S9480 and H0015 for the professional setting only.
Neighborhood Health Plan of Rhode Island	0905 for mental health IOP, 0906 for substance use IOP, 0912 or 0913 for mental health PHP	S9480, H0015, H0035, in that order	S9480 is a per diem. H0015 means a program of at least 3 hours a day on at least 3 days a week.
Tufts Health Together, RITogether and One Care	912 beside H0035, none beside S9480	H0035 and S9480	H0035: one unit for a half day, two for a full day.
Iowa Medicaid, facility-based IOP	0906	H0015, with or without TG, a two-letter modifier	Hospital outpatient departments, critical access hospitals, CMHCs and other facility types
Utah Medicaid, from January 1, 2027	0905, 0906, 0912 and 0913	S9480, H0015, H0035 and H0037, in that order	837I, one unit per day

From January 1, 2027, Utah also pairs 1001 with H0017 or H2013, and 1002 with H0018 or H2036.

Medicare bills hospital and CMHC IOP by component, not by a fixed pair. These claims carry condition code 92. Each covered service gets a revenue code and a charge. Group therapy, for example, goes under 0915 with G0410, G0411 or 90853.

Wellpoint's Iowa manual bills residential substance use services on the CMS-1450 under revenue code 906, one unit a day. So 906 means IOP in one document and residential care in another.

Where revenue-code claims break

These six patterns show up in the sources above.

A template built for one payer. Indiana pays a 905 line as a flat rate with no procedure code. For mental health IOP in an outpatient hospital setting, Blue Cross Blue Shield of Michigan's commercial plans ask for a valid procedure code combination beside 0905. A claim built for one does not fit the other.
The wrong claim form. Magellan wants 0905 on the UB-04 and S9480 on the CMS-1500. Indiana limits S9480 to the professional setting. From January 1, 2026, Tufts Health RITogether takes residential substance use claims on the CMS-1500. It uses place of service code 55, the code for a residential treatment facility. The Tufts table for Direct, Together and One Care lists 1002 with H0011 on a UB form.
Units and short days. Blue Cross and Blue Shield of Mississippi wants one unit on each PHP line for each date of service. Indiana, New Mexico and Arizona set a three-hour floor for the S9480 day. Arizona says a short day bills as individual services instead.
Bundled same-day services. Arizona calls S9480 all-inclusive and bars other behavioral health codes in the same time period on the same day. Magellan says group therapy codes do not describe IOP and cannot be accepted.
Authorization that does not match the claim. Magellan says the level of care authorized must match the care billed. It can deny a preauthorized service when the procedure codes, revenue codes or place of service differ from the authorization. Iowa Total Care's prior authorization list for its Medicaid products includes H0035 and revenue codes 912 and 913.
Moving dates. Utah's January 2026 bulletin gave July 1, 2026 as the start of its new reporting method. The September 2026 bulletin says January 1, 2027.

What we do about it

We run billing under HRI Managed, our billing engagement. Before the first claim, we confirm each payer's revenue code, HCPCS code, unit and claim form against its published policy or your contract. We track authorization and review dates to the day. A payer such as Magellan wants the level of care authorized to match the care billed. A denied or stuck claim runs through our seven-point diagnostic. We report every claim to you each Friday, with its status, age and next action. Payers change their codes, so the policy in effect for the date of service, and your contract, decide. A clean claim is not a promise of payment.

Behavioral health revenue codes on the UB-04: 0905, 0906, 0126, 1001 and 1002.

What the five codes mean.