It is important to understand the appropriate revenue codes if your facility offers inpatient detox services. Revenue Code 0116 is utilized for inpatient detoxification services, and is an important code.
Accurate claims, fewer denials, and the best possible reimbursement are guaranteed when you know when and how to use it. Here we will make you go through;
- Definition of Revenue Code 0116 and its Applicability
- When to use it and how it relates to filing a claim
- Typical pitfalls and strategies for avoiding them
- Workflow guidelines and best practices for inpatient detox service billing
This guide will help you protect your revenue cycle and expedite inpatient detox billing. Whether you’re a detox unit administrator, hospital finance manager, or behavioral-health billing team, we got you covered.
What’s Revenue Code 0116?
You must have seen 0116 on hospital claims, like the UB-04 or CMS-1450 forms. These codes show what kind of service or charge the hospital is billing for. This code also helps payers and auditors figure out exactly where the costs go.
0116 covers room and board in a private room, specifically for detoxification. If the patient’s in a semi-private room, ward, or deluxe bed for detox, you will see codes like 0126, 0136, 0146, or 0156 instead.
Hospitals use these codes for inpatient detox services. Usually for people dealing with substance use disorders who need medically managed withdrawal, or for ASAM Level IV detox.
When to Use 0116 – The Basics
- Inpatient Setting
Use 0116 only for inpatient stays and not for outpatient or residential. Perfect fit is someone in a medically managed detox bed (like ASAM Level IV).
- Detoxification Service
The main reason for the stay has to be detox for substance use disorder. It’s not for general rehab, psychiatric stabilization, or long-term care. 0116 is specifically for detox.
- Bed Type / Room Classification
Pick the right revenue code for the type of room:
Private room? Use 0116.
Semi-private (2 beds)? That’s 0126.
Three or four beds? Go with 0136, and so on.
- Compliance with Payer Requirements
Make sure the admission meets all the boxes. A medical necessity, prior authorization, ASAM criteria, and anything else the payer asks for. Some policies spell it out that detox has to be medically managed and in a hospital or ICF-A.
- Submitting Room & Board Charges
0116 covers room and board only. Bill labs, therapy, pharmacy, and other extras with their own codes. Check your contract for daily or bundled rates so you bill it right.
How to Bill Using Revenue Code 0116 Step-by-Step
Step 1: Admission & Documentation
- First, make sure the patient qualifies for inpatient detox. You’ll want to check if they meet ASAM Level IV or whatever criteria the payer uses.
- Then, get the paperwork right. You need an admission order, proof of medical necessity, and a solid detox plan in the record.
- Pick the right bed type and document the room (private, semi-private, or ward).
Step 2: Set Up the Claim on the UB-04
- In field 4, enter the bill type, like 11X for inpatient hospital.
- Use revenue code 0116 for private room detox. If it’s semi-private or ward, go with 0126 or 0156 instead.
- Add service dates and the number of units. Typically the number of room and board days.
- Make sure the main diagnosis code backs up the detox or substance use disorder admission.
- List any extra charges i.e. labs or therapy, using the right codes.
Step 3: Charge Description & Pricing
- Set your per diem rate for room and board to match what your contract or payer allows for inpatient detox.
- Clearly note that this stay is for detoxification. Some payers only pay if the revenue code makes that obvious.
Step 4: Submit and Follow Up
- Send the claim electronically to the payer.
- Watch for denials. Common issues include using the wrong revenue code, mismatched bed type, or not proving medical necessity.
- If the claim gets denied, even though you used the right code and proved medical necessity, appeal it. Include documentation showing the detox level and bed type.
Step 5: Track Metrics
Keep tabs on days in service, how often claims with 0116 get denied, your clean claim rate, and days in accounts receivable.
Best Practices for Inpatient Detox Billing with 0116
- Start by setting up a clear intake process. Get all the basics upfront i.e. insurance info, ASAM level, why the patient’s here, what kind of bed they need.
- Before sending out any claims, double-check that your revenue code lines up with the room type and the level of service you’re providing. Claims scrub tools help catch mistakes early.
- Make sure your documentation actually matches your billing. Connect the detox plan, bed assignment, and any doctor’s orders right to the claim. This backs up why you’re using 0116.
- Don’t leave staff in the dark. Teach them the details i.e. different bed types, how 0116 relates to 0126 or 0156, and what various payers expect.
- Keep tabs on how you are doing. Track how many claims go through clean, why any get denied, how long payments take, and whether things improve when you use the code correctly.
- Finally, don’t just set it and forget it. Run spot checks on claims using 0116 now and then, so you know you’re still meeting the requirements especially when payer policies change.
Also Read: Boost Collections and Cut Medical Billing Errors with RBS Innovators LLC in 2025
Wrapping Up
Revenue Code 0116 seems straightforward, but getting it right matters a lot. If you use the right documentation, classify beds correctly, and pay attention to each payer’s rules, you will see fewer denials. Moreover, you will get a better cash flow, and your team gets paid for the real work you do in medical detox.
Ready to take the stress out of inpatient detox billing and make sure every 0116 claim checks all the boxes? Don’t wait.
Book a free audit consultation. Our experts will dig into your 0116 claims together. We will help you identify the spot where revenue’s slipping through the cracks, and find solutions just for your facility.