Revenue code 0459: other emergency room
Revenue code 0459 is the catch-all in the emergency room range of the UB-04. It covers emergency room charges that the more specific 045x values do not describe, and many payers accept it only on their own short lists.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 0459 reports emergency room charges no narrower code covers. Medicare treats it like the rest of the 045x family: HCPCS on the line, reason for visit on the claim, and no use on type of bill 012x. Payer lists can be shorter than the NUBC range, so confirm 0459 is on each payer's list.
What goes under revenue code 0459?
The NCHS codebook labels 0459 as emergency room, other. It is the last value in the emergency room range that the codebook lists, after 0450, 0451, 0452 and 0456. A revenue code like this one routes a charge to a department on the UB-04, and the definition belongs to the NUBC, so the wording here is a paraphrase.
Where do procedures done in the ER go?
Chapter 4, section 180.2 says that when a surgical procedure is performed in the ER, its charge must be billed with the emergency room revenue code. If an ER visit happens the same day, the visit is a separate charge from the procedure. The manual's example uses 0450, but the rule is written for the emergency room revenue code in general, so the code your payer accepts for the department is the code that carries the procedure.
In that example both repair codes sit on 0450 lines, and the pharmacy and supply charges sit on their own revenue codes. Check how your chargemaster maps ER procedures, so a procedure is not parked on a catch-all line by default.
Which ER patients need special handling?
Section 180.6 of Chapter 4 tells hospitals to report ER services under the 045x codes and to use the date the patient entered the ER as the line date for the encounter. It also points to two cases that have their own rules and an ET modifier:
- Patients in a Part A skilled nursing facility stay: Chapter 6, section 20.1.2.2, covers hospital ER services that span several dates, with the SNF consolidated billing edits.
- Patients with end stage renal disease: Chapter 8, section 50.1.6, covers the same situation, including laboratory services.
Both cross-references sit in the ER spanning-dates section. Read the linked sections before billing 0459 for either patient type.
Does every payer accept 0459?
Not always. MassHealth's Acute Outpatient Hospital Manual appendix, transmittal AOH-23 dated July 1, 2009, lists only 0450, 0456 and 0459 under its 045X heading. That list leaves out 0451 and 0452. It is an older document, so check the current appendix, but it shows the pattern: a payer list can be narrower than the code set.
Medicare's edits are by family. Chapter 25 requires reason for visit on type of bill 013x and 085x when a 045x code is present and the FL 14 priority of visit is code 1, 2 or 5. Chapter 4 section 240.1 lists 045x among the revenue codes Medicare edits against on type of bill 012x.
What about HCPCS and the physician claim?
Chapter 4 section 20.1 requires acute care hospitals to report HCPCS codes for the services rendered. The ER physician's work goes on a separate CMS-1500 or, for a critical access hospital under Method II, on the same institutional claim with 0981. Imaging read in the ER is a professional service of its own, covered under radiology billing. Chapter 25 says that where a hospital bills gross, the physician component must still be billed to the Part B MAC to obtain payment.
Where does revenue code 0459 sit on the claim, and what does the remittance show?
0459 is the other emergency room code. It still takes a HCPCS code in FL 44 and a line date in FL 45. CMS gives an example of ER procedures billed under the emergency revenue code, separate from the visit.
Read the CARC and LQ remark on the line; a CO-16 with M51 points to the procedure code in FL 44.
A 0459 line returns CO-16 with RARC M51 for $310.00.
Why do 0459 lines get denied?
| Code | What X12 says | Where it shows up on a 0459 line |
|---|---|---|
| CO-16 with RARC M51 | Claim lacks information or has a billing error; M51 is missing, incomplete or invalid procedure code | 0459 used with no HCPCS code, or with a code that does not describe the service |
| CO-97 | The benefit is included in the payment for another service already adjudicated | A procedure or supply line the payer packages into the ER visit |
| CO-109 | Claim or service not covered by this payer or contractor, send to the correct payer | The ER claim went to a plan that is not the right primary payer |
If these denials keep coming back, our denial management team can work them. The facility workflow is on hospital and facility billing.
Related codes
- Restricted-use Linked NCHS-CMS Medicare Data: Outpatient Revenue Center codebook · CDC / NCHS
- Medicare Claims Processing Manual, Chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS) · CMS
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
- MassHealth Acute Outpatient Hospital Manual, Appendix F: Revenue Codes (transmittal AOH-23, 07/01/09) · MassHealth
- Claim Adjustment Reason Codes · X12
- Remittance Advice Remark Codes · X12
- Medicare Claims Processing Manual, chapter 25, section 75 (UB-04 form locators 42 and 44) · CMS
- Medicare Claims Processing Manual, chapter 22, sections 60.1 to 60.3 (group codes, CARC, RARC on the remittance) · CMS
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Common questions
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01What goes under revenue code 0459?
Emergency room charges that no narrower 045x value describes. The NCHS codebook labels it emergency room, other. Use 0450, 0451, 0452 or 0456 when one of those fits, and keep 0459 for what is left. It is a UB-04 hospital code, not a professional claim code.
02Is 0459 accepted by every payer?
No. Payers publish their own lists. MassHealth's 2009 acute outpatient hospital appendix listed 0450, 0456 and 0459 under 045X but not 0451 or 0452. Check the current manual of each payer before you rely on any value in the range.
03Where do ER procedures go, 0450 or 0459?
Chapter 4 section 180.2 says the procedure charge goes under the emergency room revenue code and is billed apart from the visit. CMS's example uses 0450. Use whichever emergency room code your payer accepts for the department, and keep the visit and the procedure consistent.
04Can I bill 0459 on a 012x bill?
Not with Medicare. Chapter 4 section 240.1 lists 045x among the revenue codes the system edits against on type of bill 012x. The line comes back with group code PR, CARC 96 and RARC M28. Outpatient ER care belongs on 013x.
05Does 0459 change how the ER physician is paid?
No. The revenue code describes the hospital charge. The physician is paid on a CMS-1500, or through revenue code 0981 on a Method II critical access hospital claim. Chapter 25 says the physician component must still be billed to the Part B MAC where the hospital bills gross.
Catch-all ER lines drawing payer questions?
We map each ER charge to the revenue code the payer accepts before billing.