Revenue code 0115 is an institutional charge code on the UB-04 (CMS-1450) claim form for private (one-bed) hospice patients’ daily room-and-board.
Revenue codes are assigned by the National Uniform Billing Committee (NUBC) and used by Medicare in its processing guides. All 0110–0119 codes are “Room & Board – Private (1 bed)”.
In this series, revenue code 0115 means “Room & Board – Private (one bed) – Hospice”. In practice, RC 0115 appears on hospital or nursing facility claims to indicate that the accommodation days billed are for a hospice patient.
| Revenue Code | Description (Private 1-bed) |
| 0110 | General classification |
| 0111 | Medical/Surgical/Gynecological |
| 0112 | Obstetrics (OB) |
| 0113 | Pediatric |
| 0114 | Psychiatric |
| 0115 | Hospice |
| 0116 | Detoxification |
| 0117 | Oncology |
| 0118 | Rehabilitation |
| 0119 | Other (unspecified private room) |
Note: Revenue Codes 0110–0119 are all variants of private-room charges. Code 0115 is designated for “Hospice” (private, one-bed) room-and-board.
Form Locator 42 (Rev Code) on the UB-04 explains FL 47 charges with revenue codes. For a private hospice room charge, enter 0115 in FL42, the number of days (units) in FL46, and the total room/board charge in FL47. Pure accommodation charges have blank NPR (HCPCS/CPT Codes) fields (FL44). Ancillary services have their own revenue codes and HCPCS on separate lines. On the UB-04, 0115 means “private room & board – hospice level of care.”
Importance of Revenue Code 0115 in Inpatient Billing
Institutional (facility) claims use revenue code 0115, not CPT or diagnostic codes. It alerts the payer that the patient was inpatient for hospice care and billed as room/board. Psychiatric and other acute care inpatient billing uses different codes (P0114 for a private room). Revenue Code 0115 is not used for routine psychiatric admissions. Actually, NUBC lists 0114 for private psychiatric rooms and 0115 for hospice. Thus, 0115 applies to hospice inpatients.
- A patient receiving General Inpatient (GIP) hospice care in a hospital or hospice facility that charges room/board.
- Hospice patients in private rooms in nursing homes (SNFs) are billed for room/board.
- Any hospice-designated inpatient or hospice care center (if contracted to bill separately).
Medicare pays for inpatient hospice days (GIP) using revenue code 0656 (General Inpatient) and site-of-service HCPCS. The hospital bills the hospice agency directly for room/board using code 0115, not Medicare. For non-Medicare payers (Medicaid or commercial), some allow the hospital/SNF to bill the insurer directly with revenue code 0115, while others require the hospice agency to pay.
Common Scenarios for Revenue Code 0115
Revenue code 0115 is used in different scenarios, for example:
Hospice General Inpatient (GIP) Care
A patient under hospice who needs 24-hour nursing (e.g. uncontrolled symptoms) may be admitted to a hospital or hospice unit for GIP. If the payer allows facility billing, the hospital will put RC 0115 on the UB-04 for each inpatient day. (Medicare itself does not pay the hospital; the hospital bills the hospice with 0115.)
Ensuring accurate use of this code is essential, and partnering with a medical billing company can help facilities maintain proper hospice billing practices, prevent denials, and secure correct reimbursement for GIP services.
Hospice in a Nursing Home
A hospice-enrolled patient in a nursing facility (SNF) occupying a private room may generate room/board charges. Many SNFs bill hospices for this via UB-04 lines with revenue code 0115 (per CM/NFPA guidelines).
Commercial/Medicaid Plans
Some state Medicaid or commercial plans cover hospice inpatient care under the facility’s license. For example, a commercial plan might require the hospital to bill room/board days to that plan using 0115 when the patient is on hospice.
Contracted Hospice Beds
Hospitals or SNFs that provide designated hospice beds may use 0115 to bill room & board when the patient elects hospice.
Revenue Code 0115 Relationship to Other Codes
Revenue code 0115 is an accommodation code, so it generally does not pair with a CPT (procedure) code on the same line; rather, it stands alone as the identifier of room/board charges. On an 837I/UB claim, each line has a Rev Code and, if applicable, a HCPCS code and charge. For a pure room charge, the HCPCS field (FL44) is usually left blank. (If the payer requires it, an inpatient hospice level-of-care code like HCPCS Q5003 might appear on the hospice’s own claim, but not typically on the hospital’s 0115 line.)
Diagnosis Codes
The UB-04 will include ICD-10 diagnosis codes (Form Locator 67). The principal diagnosis should justify hospice care (for example, advanced cancer, end-stage organ failure, etc.). Often coders also include an additional code for the encounter type, e.g. Z51.5 (Encounter for palliative care) or Z51.89 (Other medical care) to indicate hospice/palliative focus. In any case, the diagnosis codes on the claim should reflect terminal illness or symptom control needs to support the hospice admission.
TOB and Units
When billing 0115, the claim’s Type-of-Bill (TOB) must be the hospice series (normally 081x for non-hospital-based or 082x for hospital-based, with the 4th digit indicating claim frequency). The number of days is reported as “Units” in FL46. For example, a three-day hospice stay would have 0115 in FL42, Units=3 in FL46, and the total charge for 3 days in FL47.
Coordination with Hospice Billing
Remember that Medicare’s payment split means the hospice agency files a hospice claim (using revenue code 0656 for GIP and HCPCS Q500x for site-of-service) and the hospital may only invoice the hospice separately. For non-Medicare payers, it depends on contract – either the hospice uses 0656 or the facility uses 0115 to bill the insurer. In any event, CPT codes (for physician or outpatient services) are not on the 0115 line itself; they appear on separate professional or outpatient claims as appropriate.
Documentation Requirements and Compliance Tips
Accurate use of Revenue code 0115 requires thorough documentation and strict adherence to payer rules:
Hospice Election & Certification
The patient’s chart must have a signed hospice election (CMS Form 0B110) and physician certification/recertification of terminal illness (physician orders and Form 486/500/502 as required) for the period in question. Missing a valid hospice election or certification is a common cause of denial.
Level-of-Care Orders
The physician’s orders should justify the inpatient hospice level of care (e.g. uncontrolled pain, severe symptoms). Clinical notes should support why GIP (General Inpatient) was needed on each day.
Type of Bill (TOB)
Use the appropriate hospice bill type (081x or 082x) when filing a claim with 0115, and set the 4th digit for claim frequency (1=admit-to-discharge, 2=first interim, 3=continuing, 4=last interim). Using a non-hospice TOB (e.g. an acute care 13x) can trigger a reject.
Diagnosis Codes
Put the primary terminal diagnosis (e.g. metastatic cancer code) as principal; add Z51.5 or Z51.89 as a secondary code for encounter/palliative care. These codes help justify the hospice level-of-care.
Contract Verification
Always check payer policy. Medicare Advantage, Medicaid, or commercial insurers each have specific rules for whether the facility can bill 0115 or if the hospice handles the payment. If the policy prohibits 0115 billing (e.g. “hospice pays all” models), attempting to bill it will result in denial.
RC 0115 Importance for Reimbursement
For correct reimbursement and no claim denials, revenue code 0115 must be used correctly. Revenue code 0115 transfers lodging costs to hospice benefits. For Medicare GIP days, the hospice agency receives 0656+Q500x and the hospice contract pays the hospital separately. Use 0115 instead of a general room code for other payers to ensure hospice coverage.
Revenue Code 0115 determines who pays and how much. This tells payers these days are hospice days. Proper use prevents mistaken benefit payments. One hospice billing guide suggests billing 0656 for Medicare hospice and 0115 for others if the payer allows facility billing for room/board. Coding errors can result in recoupments or audits, so match it to the level of care and payer rules.
Accurate usage of this code is vital for effective revenue cycle management services, as it ensures clean claims, prevents recoupments or audits, and aligns reimbursement with the correct level of care and payer rules. By integrating proper coding practices within your revenue cycle management workflow, facilities can maintain compliance, reduce denials, and optimize financial performance.
Common Errors While Using RC 0115 and How to Avoid Them
Using revenue code 0115 correctly can add more to your revenue sheet, but if you make some mistakes, it can cause you to lose money too. Here I discuss some common errors while using revenue code 0115, and also discuss how to avoid them to get the full fruit of your care services.
Using 0115 on Medicare Claims
Medicare Part A does not pay the hospital for inpatient hospice days. Many providers mistakenly bill 0115 to Medicare; this will be denied because Medicare expects the hospice to use 0656.
Do not include 0115 on a Medicare inpatient claim – instead invoice the hospice under contract.
Missing Hospice Election/Certification
If the patient’s hospice election or recertification paperwork is missing, the entire stay (and 0115 charges) will be disallowed.
Ensure the election form and all physician certifications are in the chart and on the claim cover period.
Wrong TOB or Frequency
Billing 0115 on an acute-care bill type (13x TOB) or forgetting to set the frequency digit causes rejections.
Use a hospice bill type (081x/082x) and correct 4th digit (1–4).
Ignoring Payer Rules
Some insurers do not allow the facility to bill 0115 at all, even if the patient is in hospice. Other payers allow it.
Always check the contract or policy. If 0115 is not permitted, do not bill it – follow the payer’s required billing pathway.
No Interim Billing on Long Stays
Waiting until discharge to bill many hospice days can risk denials or cash flow issues.
Submit interim (e.g. monthly) claims for extended hospice stays when allowed, rather than one final claim.
Double Billing
Be careful not to double-dip. For example, if the hospice benefit covers certain hospice-specific services, do not have the hospital also bill those services separately. Maintain clear separation of the room/board charges (0115) from any other service charges.
By following documentation rules and payer instructions, these errors can be minimized. In sum, apply 0115 only when a hospice patient truly occupies a private room under a payer’s hospice benefit, and bill it only in the situations the payer expects.