Billing Information includes which item on the UB-04 form?

• A. Pay-to name and address
• B. Admission time
• C. Date of birth
• D. Revenue codes

Answer: (D)

Revenue codes are used on the UB-04 to categorize each charge by the service location or department providing the care (for example, room and board, radiology, laboratory). This categorization is essential for billing because it tells the payer how to route and pay each charge, tying the line item to the appropriate service area. The other items listed belong to different areas: pay-to name and address relates to who gets paid, admission time is part of the admission/encounter data, and date of birth is patient demographic information. Therefore, revenue codes are the element that fits under Billing Information.