Revenue Code 0510 is a medical billing code used when a patient receives basic care at a hospital-owned outpatient clinic. This code specifically applies to the facility charges including the use of the exam room, nursing services, clinic staff, medical supplies, and utilities.
It does not cover physician services. Those are billed separately using CPT or HCPCS codes. Proper use of revenue code 0510 ensures accurate outpatient clinic billing and helps hospitals receive appropriate reimbursement for the facility component of outpatient visits.
How Revenue Code 0510 Fits Into the Coding System
To understand revenue code 0510, it helps to know its place among revenue codes. The 051X series covers different types of clinic settings. 0510 is the “general outpatient clinic” code.
Other codes in the 051X group include:
- 0511: chronic pain center
- 0512: dental clinic
- 0514: OB/GYN clinic
- 0515: pediatric clinic
0510 is the default for general clinic services in a hospital setting. If a visit belongs to a specialty clinic, other revenue codes are applied.
When to Use Revenue Code 0510
You should use Revenue Code 0510 when the patient visit happens in a hospital-owned or provider-based clinic and involves general, non-specialized care.
Here’s when it fits the best:
Routine outpatient visits at hospital-owned clinics
Use 0510 when a patient comes for a normal, non-emergency visit. For example, a person comes for a cough, minor pain, or a refill. The nurse checks their vitals, and the doctor gives basic advice. Nothing complex or specialized, just regular outpatient care.
Follow-ups, checkups, and basic consultations
RC 0510 works well for simple follow-ups after a previous visit. Say a patient returns after a cold to make sure they’re okay, or they come for a quick checkup. These are normal visits that use clinic space and staff but don’t need advanced procedures.
Visits where clinic staff and a room were used
Revenue Code 0510 tells the payer that the clinic’s resources were used like exam rooms, nursing help, front desk, and supplies. Even if the visit was short, as long as clinic space and staff were used, this code applies.
Medicare and major payer acceptance
Medicare accepts 0510 for outpatient clinic services that are part of a hospital system. Make sure to pair it with the correct CPT or HCPCS code. If you only list 0510 without a matching procedure code, Medicare or other payers may deny the claim.
When Not to Use Revenue Code 0510
Don’t use 0510 when the care is specialized, emergency-related, or outside the general clinic scope.
Here’s when to skip it:
Emergency room visits and urgent care
Use a different revenue code (like revenue code 0450 for ER). If a patient walks into the emergency department, it’s not a general clinic visit, it’s emergency care. RC 0510 would be wrong here.
Surgical or operating room encounters
Any visit involving surgery or procedures in an operating room has its own revenue code 0360. The 0510 code is not meant for these visits because they use surgical resources, not routine clinic space.
Lab-only, imaging-only, or pharmacy-only visits
If a patient only comes for a blood test, X-ray, or to pick up medication, use the specific revenue code for that service (like 0300 for lab or 0320 for radiology). The clinic itself wasn’t used, so 0510 doesn’t apply.
Specialty care or diagnostic visits
For visits focused on a particular specialty like cardiology, dermatology, or orthopedics — use the matching specialty clinic code (such as 0520). RC 0510 is only for general outpatient clinic services, not focused specialties.
Independent physician offices
If the clinic is not owned by a hospital, you can’t use 0510. Independent practices usually bill only professional services using CPT codes, not facility fees.
Medical Billing Reimbursement Rates for Revenue Code 0510
Let’s talk about the dollars. It is the part everyone actually cares about.
The reimbursement rates for Revenue Code 0510 vary across payers, contracts, and clinic types.
Even though this code represents something as simple as a routine clinic visit, the payment you get can differ a lot from one insurance company to another, or one state to another.
Average Reimbursement Rates (Mid-2025 Estimates)
Below are the national average facility reimbursement rates for claims billed with Revenue Code 0510, based on fee schedule and contract data from mid-2025.
Keep in mind, these are facility-side payments only, not including the provider’s CPT-based professional fee.
| Payer | Average Reimbursement (Facility Side) | Notes |
| Blue Cross Blue Shield (BCBS) | ~$3,002.58 | Often higher due to hospital network contracts and bundled arrangements. |
| UnitedHealthcare (UHC) | ~$145.57 | Moderate rate reflecting outpatient clinic facility reimbursement. |
| Aetna | ~$212.48 | Competitive for hospital-based clinics, though varies by state. |
| Cigna | ~$161.93 | Typical range for general outpatient visits under 0510. |
| Medicare (Average Outpatient Rate) | ~$128.00 | Facility rate under OPPS; varies by wage index and APC group. |
Common Issues with Revenue Code 0510 Claims
Denials related to 0510 often come from small mismatches or missing details. Here are the most frequent reasons payers reject these claims:
Missing CPT/HCPCS codes on the same date of service
Facility charges under 0510 must always be tied to a valid CPT or HCPCS code that represents the professional service performed. If the claim only includes the revenue code without the paired procedure, it will be denied for “invalid or incomplete coding.”
Mismatch between revenue code and procedure code
Some clinics mistakenly pair 0510 (general outpatient clinic) with specialty procedures like cardiology, dermatology, or surgery. Payers’ edits flag these mismatches and require the appropriate specialty revenue code (e.g., 0513, 0514, 0360).
Incorrect location code or non-hospital facility
0510 is intended for hospital-owned outpatient departments (HOPDs) or provider-based clinics. If a claim lists a place of service (POS) for a freestanding clinic or private office, payers will deny the facility charge entirely.
Improper split billing
Some hospitals attempt to split a single visit into separate facility and professional claims even when the payer’s contract doesn’t allow it. Payers can deny the 0510 line for “duplicate” or “unbundled” billing.
Lack of supporting documentation
Even if the codes look right, payers may request proof that facility resources were actually used — such as nursing time, exam room occupancy, and clinical staff involvement. If that documentation isn’t available or doesn’t match the visit, payment may be withheld.
How to Fix and Appeal Revenue Code 0510 Denials
The good news is that most 0510-related denials are reversible if you respond quickly and clearly. Here’s a practical step-by-step approach:
Review the Explanation of Benefits (EOB) or denial notice
Carefully read the payer’s denial reason. It often points to the exact issue, such as “invalid procedure-to-revenue code combination” or “facility not eligible.” Understanding the payer’s logic helps you target your appeal correctly.
Verify claim details against payer rules
Compare the denied claim to the payer’s published billing guidelines. Make sure the location, revenue code, and CPT/HCPCS combination are valid for the payer and the date of service.
- If a payer follows CMS Outpatient Code Editor (OCE) rules, use those crosswalks to check if 0510 was allowed for that CPT.
- If the payer uses internal edits, reference their provider manual or contact your representative for clarification.
Attach strong supporting documentation
Payers want to see evidence that a clinic visit truly used facility resources. Include:
- Nursing and vital sign logs
- Patient registration forms
- Exam room assignment or room-use logs
- Provider progress notes indicating clinic space was used
- Supply lists or staff involvement records
- These records confirm that the facility fee under 0510 was justified.
Submit a corrected claim or formal appeal
- For small coding errors (like missing CPT), submit a corrected claim through your billing system.
- For larger disputes, prepare a written appeal with a concise explanation. Reference documentation, payer policies, and the medical record to support your position.
Track and follow up
After submission, monitor the appeal status in the payer portal. Keep a log of dates, contact names, and reference numbers. Timely follow-up often accelerates payment resolution.
FAQs
Answers to your questions:
Can Revenue Code 0510 be used for telehealth visits?
No, typically not. Revenue Code 0510 is meant for in-person outpatient clinic services where the hospital’s physical resources (exam room, nursing staff, etc.) are used.
For telehealth, CMS and many payers require a different place of service (POS) and often do not permit a facility fee unless the patient is physically located at the hospital clinic during the virtual encounter (e.g., for hub-and-spoke setups).
If you’re billing for telehealth in a hospital-owned clinic, you’d typically use:
- POS 02 or 10 (depending on payer rules)
- No revenue code unless tied to originating site or special arrangement
Is Revenue Code 0510 used in Ambulatory Surgical Centers (ASCs)?
No. ASCs do not use revenue codes like 0510 because they are reimbursed under a different payment system — the ASC payment system, not the Outpatient Prospective Payment System (OPPS).
Revenue Code 0510 is specific to hospital outpatient departments (HOPDs). Using it in an ASC setting would be inappropriate and likely lead to claim denial.
Can multiple revenue codes (including 0510) appear on the same outpatient claim?
Yes, absolutely. A single outpatient claim may include multiple revenue codes — each representing different services rendered on the same date of service.
Example:
- 0510 – General clinic use
- 0300 – Laboratory services
- 0320 – Diagnostic radiology
This is common when a patient receives general care and additional services (like labs or imaging) in the same visit. Each revenue code must align with the proper CPT/HCPCS code to avoid mismatched billing.
Are there differences in how Medicaid reimburses for 0510 vs. Medicare?
Yes, Medicaid programs vary by state. While Medicare uses a national OPPS fee schedule, Medicaid is state-administered, so:
- Some Medicaid plans bundle 0510 into per-visit payments or capitation
- Others may deny 0510 unless specific CPT codes are attached
- Documentation and facility requirements are often stricter in Medicaid to avoid duplicative billing
Always consult the state-specific Medicaid billing guide for guidance on outpatient clinic revenue codes.
Does Revenue Code 0510 require a modifier?
Not inherently, but modifiers may be required depending on:
- The CPT/HCPCS code used alongside 0510
- The payer
- The site of healthcare service
For example:
- Modifier 25 might be needed on the E/M code if a significant, separately identifiable service was provided during the clinic visit
- Modifier PO (for off-campus provider-based departments) is often required for hospital outpatient claims under Medicare OPPS.
Incorrect or missing modifiers can lead to reduced reimbursement or full denials.
Can Revenue Code 0510 be used for a nurse-only visit?
Yes, if certain conditions are met. If a nurse-only visit involves:
- Use of clinic space (exam room)
- Use of hospital clinic staff and resources
- Documentation of care (e.g., vitals, wound check, injection)
then 0510 can be appropriate — but it must still be paired with a valid HCPCS/CPT code (e.g., for injections, vitals check, etc.).
Without a billable professional service, some payers will deny 0510-only claims as insufficient.
Can Revenue Code 0510 be used for behavioral health visits?
It depends. If behavioral health services occur in a hospital-owned general outpatient clinic, and are non-specialized, 0510 might apply.
However, most mental health services are provided through:
- Revenue Code 0900 series (e.g., 0910 for individual therapy)
- Behavioral health-specific billing rules
If the hospital has a designated behavioral health clinic, you must use the appropriate mental health revenue code instead of 0510.
Is documentation required to prove use of 0510?
Yes, and increasingly so. Many payers now require documentation proving that:
- Clinic space was used
- Staff time was spent (e.g., nurse triage, vital signs)
- The visit was more than a brief conversation or prescription refill
Acceptable documentation includes:
- Nursing or triage notes
- Room logs or scheduling system printouts
- Supplies administered or consumed
- Clinical progress notes indicating clinic resource use