CIGNA BEHAVIORAL HEALTH REVENUE CODES …

1 CCIIGGNNAA BBEEHHAAVVIIOORRAALL HHEEAALLTTHH REVENUE CODES AND DESCRIPTIONS code SUB CATEGORY STANDARD ABBREVIATIONS 001 Total charges 01X Reserved for internal payer use HEALTH Insurance Prospective Payment Systems (HIPPS) 0 - RESERVED 1 - RESERVED 2 - Skilled Nursing Facility Prospective Payment SNF PPS (RUG) 3 - Home HEALTH Prospective Payment System HH PPS (HRG) 4 - Inpatient Rehab Facility Prospective Payment REHAB PPS (CMG)

2 5 - RESERVED 6 - RESERVED 7 - RESERVED 8 - RESERVED 02X 9 - RESERVED 03X to 06X Reserved for National Assignment 07X to 09X Reserved for State Use ACCOMMODATION REVENUE CODES (10X - 21X) All Inclusive Rate Flat fee charge incurred on either a daily basis or total stay basis for services rendered. Charge may cover room and board plus ancillary services or room and board only.

3 0 - All-Inclusive Room and Board Plus Ancillary ALL INCL R&B/ANC 10X 1 - All-Inclusive Room and Board ALL INCL R&B Room & Board - Private (Medical or General) Routine service charges for single bed rooms. Rationale: Most third party payers require that private rooms be separately identified. 0- General Classification ROOM-BOARD/PVT 1 - Medical/Surgical/Gyn MED-SUR-GY/PVT 2 - OB OB/PVT 3 - Pediatric PEDS/PVT 4 - Psychiatric PSYCH/PVT 5 - Hospice HOSPICE/PVT 6 - Detoxification

4 DETOX/PVT 7 - Oncology ONCOLOGY/PVT 8 - Rehabilitation REHAB/PVT 11X 9 - Other OTHER/PVT Room & Board - Semi-private Two Bed (Medical or General) Routine service charges incurred for accommodations with two beds. Rationale: Most third party payers require that semi-private rooms be identified. 0- General Classification ROOM-BOARD/SEMI 1 - Medical/Surgical/Gyn MED-SUR-GY/2 BED 2 - OB OB/2 BED 3 - Pediatric PEDS/2 BED 4 - Psychiatric PSYCH/2 BED 5 - Hospice HOSPICE/2 BED 6 - Detoxification

5 DETOX/2 BED 7 - Oncology ONCOLOGY/2 BED 12X 8 - Rehabilitation REHAB/2 BED 1 CCIIGGNNAA BBEEHHAAVVIIOORRAALL HHEEAALLTTHH REVENUE CODES AND DESCRIPTIONS code SUB CATEGORY STANDARD ABBREVIATIONS 9 - Other OTHER/2 BED Semi-Private - Three and Four Beds Routine service charges incurred for accommodations with three and four beds.

6 0- General Classification ROOM-BOARD/3&4 BED 1 - Medical/Surgical/Gyn MED-SUR-GY/3&4 BED 2 - OB OB/3&4 BED 3 - Pediatric PEDS/3&4 BED 4 - Psychiatric PSYCH/3&4 BED 5 - Hospice HOSPICE/3&4 BED 6 - Detoxification DETOX/3&4 BED 7 - Oncology ONCOLOGY/3&4 BED 8 - Rehabilitation REHAB/3&4 BED 13X 9 - Other OTHER/3&4 BED Private (Deluxe) Deluxe rooms are accommodations with amenities substantially in excess of those provided to other patients.

7 0- General Classification ROOM-BOARD/PVT/DLX 1 - Medical/Surgical/Gyn MED-SUR-GY/DLX 2 - OB OB/DLX 3 - Pediatric PEDS/DLX 4 - Psychiatric PSYCH/DLX 5 - Hospice HOSPICE/DLX 6 - Detoxification DETOX/DLX 7 - Oncology ONCOLOGY/DLX 8 - Rehabilitation REHAB/DLX 14X 9 - Other OTHER/DLX Room & Board Ward (Medical or General) Routine service charge for accommodations with five or more beds.

8 Rationale: Most third party payers require ward accommodations to be identified. 0- General Classification ROOM-BOARD/WARD 1 - Medical/Surgical/Gyn MED-SUR-GY/WARD 2 - OB OB/WARD 3 - Pediatric PEDS/WARD 4 - Psychiatric PSYCH/WARD 5 - Hospice HOSPICE/WARD 6 - Detoxification

9 DETOX/WARD 7 - Oncology ONCOLOGY/WARD 8 - Rehabilitation REHAB/WARD 15X 9 - Other OTHER/WARD Other Room & Board Any routine service charges for accommodations that cannot be included in the more specific REVENUE center CODES . Rationale: Provides the ability to identify services as required by payers or individual institutions.

10 Sterile environment is a room and board charge to be used by hospitals that are currently separating this charge for billing. 0 - General Classification R&B 16X 4 - Sterile Environment R&B/STERILE 2 CCIIGGNNAA BBEEHHAAVVIIOORRAALL HHEEAALLTTHH REVENUE CODES AND DESCRIPTIONS code SUB CATEGORY STANDARD ABBREVIATIONS 7 - Self Care R&B/SELF 9 - Other R&B/Other Nursery Charges for nursing care to newborn and premature infants in nurseries.