UB-04 Revenue Code 0430: Occupational Therapy

Overview

Revenue Code 0430 represents the General category for Occupational Therapy services on the UB-04 claim form. It falls under the 043X series, which includes five sub‑codes: 0430 General, 0431 Visit charge, 0432 Hourly charge, 0433 Group rate, 0434 Evaluation, and 0439 Other. ^[1]
Occupational therapy is a distinct therapeutic service, separate from physical therapy (042X) and speech therapy (044X). ^[1]
The UB-04 form is required by MassHealth for hospitals, skilled nursing facilities, home health agencies, and other institutional providers. ^[2]

When to Use

Code 0430 is used when billing for occupational therapy services under a general, unclassified billing category. It should be selected when no more specific sub‑code (such as a visit charge or hourly charge) applies. ^[1]
For a per‑visit charge, use 0431; for an hourly rate, use 0432; for group therapy, use 0433; for an evaluation only, use 0434; and for any other occupational therapy service not listed, use 0439 (Other). ^[1]
The code must match the type of service billed. ^[2]

Step-by-Step Claim Example

Scenario: A hospital outpatient department provides a 45‑minute occupational therapy session. The charge is $150. No other therapy services are billed on the same claim.

1. Form Header: Complete the UB-04 with the provider’s NPI, member’s information, and any required prior authorization numbers.
2. Revenue Code Line: In the “Revenue Code” field (Field 42), enter 0430 (General Occupational Therapy). ^[1]
3. Description: Optionally enter “Occupational Therapy” in the service description column.
4. Charges: Enter the total charge of $150.00 in the “Total Charges” or “Service Line Charge” column.
5. Units: Enter 1 if billing per session, or the appropriate number of hours/minutes if using an hourly code (e.g., 0432). For this general code, one unit is typical unless the payer requires a different unit definition.
6. Bundling: If there are other occupational therapy visits on the same date, bundle them into a single line using code 0430 or use separate lines with appropriate sub‑codes. ^[2]
7. Additional Lines: Do not exceed 22 revenue code lines on the form. ^[2]

Common Mistakes & Audit Red Flags

• Using the Wrong Sub‑code: Applying code 0430 when the service is clearly an evaluation (0434) or a visit charge (0431) may lead to claim rejection or audit scrutiny. ^[1]
• Bundling Errors on Outpatient Claims: MassHealth requires outpatient providers to bundle services onto a single form. Failing to combine multiple occupational therapy sessions or mixing occupational therapy with unrelated services (e.g., physical therapy) without proper line‑item separation can cause payment delays. ^[2]
• Exceeding Line Limit: For inpatient claims, listing more than 22 revenue code lines on a paper form is not allowed. Providers must submit electronically if the claim exceeds this limit. ^[2]
• Missing Prior Authorization: (Not mentioned in sources – cannot cite, so omit.)
• Incorrect Unit of Service: Using code 0430 with an hourly unit count (e.g., 0.75 hours) when the payer expects whole‑session units can cause inconsistency. The Noridian list distinguishes “Hourly charge” (0432) from “General” (0430). ^[1]

Related Codes/Fields

The following table lists the related revenue codes within the 043X series and adjacent therapy codes for reference.

Revenue Code	Description
0430	Occupational Therapy – General
0431	Occupational Therapy – Visit charge
0432	Occupational Therapy – Hourly charge
0433	Occupational Therapy – Group rate
0434	Occupational Therapy – Evaluation
0439	Occupational Therapy – Other
042X	Physical Therapy (0420 General, 0421 Visit, 0422 Hourly, 0423 Group, 0424 Evaluation, 0429 Other)
044X	Speech Therapy (0440 General, 0441 Visit, 0442 Hourly, 0443 Group, 0444 Evaluation, 0449 Other)

All codes listed are from ^[1].
Revenue codes appear in Field 42 of the UB-04 claim form. ^[2]

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References

[1] Noridian Revenue Codes — https://med.noridianmedicare.com/web/jea/topics/claim-submission/revenue-codes

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download