Private room billing is one of the most misunderstood areas of hospital revenue management. Many hospitals assume that if a patient stays in a private room, it can automatically be billed separately. That assumption is wrong and it leads to denials, patient complaints, and compliance risk.
Revenue Code 0119 exists specifically to report private room charges, but it must be used correctly and only under the right circumstances.
This guide explains Revenue Code 0119, when it applies, how reimbursement works, and how hospitals can avoid costly billing mistakes.
What Is Revenue Code 0119?
Revenue Code 0119 is an inpatient room and board revenue code used to bill private room accommodations. It falls under the broader room and board category (Revenue Codes 0100–0199) and is meant to represent non-standard room charges that are not part of routine ward or semi-private room billing.
Key point:
Revenue Code 0119 is not automatically reimbursed. It often represents a non-covered or patient-responsible charge, depending on payer rules.
When Revenue Code 0119 Should Be Used
Revenue Code 0119 should only be used when:
- A patient occupies a private room by choice
- The private room is not medically necessary
- The payer allows reporting of private room charges
- The charge is not included in standard room reimbursement
It is commonly used in:
- Inpatient hospital stays
- Elective admissions
- Patient-requested private accommodations
Using this code incorrectly is one of the fastest ways to trigger claim issues.
Medical Necessity vs Patient Preference
This distinction decides everything.
Medically Necessary Private Rooms
If a private room is medically necessary (e.g., isolation, infection control), it is not billed under Revenue Code 0119. Instead, it is billed under the appropriate standard room revenue code, because the payer considers it part of covered care.
Patient-Requested Private Rooms
If a patient requests a private room for comfort or privacy:
- Revenue Code 0119 may apply
- Charges are often non-covered
- Patient financial responsibility must be disclosed
Hospitals that ignore this distinction end up with denied claims or billing disputes.
Revenue Code 0119 and Medicare Rules
Medicare generally does not reimburse private room charges unless medically necessary.
For Medicare patients:
- Private room charges billed under 0119 are typically non-covered
- Charges may shift to patient responsibility
- Advance Beneficiary Notice (ABN) may be required
Billing Revenue Code 0119 to Medicare as a covered charge is a mistake and often results in adjustments or denials.
Revenue Code 0119 and Commercial Payers
Commercial payer rules vary significantly.
Some commercial plans:
- Allow partial reimbursement for private rooms
- Treat private rooms as upgrade charges
- Require patient consent documentation
Others deny private room charges entirely. Hospitals must follow payer-specific contracts, not assumptions.
Reimbursement Structure for Revenue Code 0119
There is no standard reimbursement rate for Revenue Code 0119.
Reimbursement depends on:
- Payer policy
- Contract terms
- Patient responsibility rules
- Medical necessity documentation
In many cases, Revenue Code 0119 charges are:
- Non-covered
- Patient-pay
- Excluded from DRG or bundled payments
Expecting insurance reimbursement by default is unrealistic.
Common Billing Mistakes with Revenue Code 0119
Hospitals repeatedly make these errors:
1. Billing 0119 Without Patient Consent
If the patient did not knowingly request a private room, billing them later creates disputes and compliance issues.
2. Using 0119 for Medically Necessary Rooms
Isolation rooms billed under 0119 cause underpayment and incorrect patient charges.
3. No Documentation Support
Lack of documentation explaining why the private room was used weakens billing justification.
4. Ignoring ABN Requirements
For Medicare patients, failure to issue an ABN can make charges uncollectible.
Documentation Requirements for Revenue Code 0119
Strong documentation is mandatory.
Documentation should include:
- Patient request or consent
- Room type assigned
- Reason for private accommodation
- Financial disclosure acknowledgment
Without documentation, Revenue Code 0119 charges are indefensible.
Revenue Code 0119 and Patient Billing Transparency
Private room charges are sensitive. Patients often assume insurance will pay.
Hospitals must:
- Inform patients in advance
- Clearly explain non-covered charges
- Separate private room charges on statements
Poor communication leads to complaints, disputes, and write-offs.
Compliance and Audit Risk
Auditors review private room billing closely because:
- It affects patient liability
- It is prone to misuse
- It can hide improper billing practices
Patterns of excessive 0119 usage raise red flags.
Best Practices for Using Revenue Code-0119
Hospitals should implement:
- Clear private room billing policies
- Staff training on room revenue codes
- Patient consent procedures
- Regular billing audits
- Payer rule reviews
These steps reduce denials and protect patient trust.
Revenue Code 0119 and Denial Management
If Revenue Code-0119 claims are denied:
- Review medical necessity vs preference
- Check payer policy
- Validate documentation
- Adjust billing approach
Blind resubmission wastes time and guarantees repeat denials.
Why Private Room Billing Needs Expert Oversight
Private room billing sits at the intersection of:
- Revenue integrity
- Compliance
- Patient satisfaction
Internal teams often misapply rules, leading to lost revenue or reputational damage.
How NAHL Helps Hospitals Bill Revenue Code 0119 Correctly
NAHL supports hospitals with accurate inpatient billing, including Revenue Code-0119 compliance and optimization. We ensure private room charges are billed correctly, transparently, and in line with payer rules.
NAHL helps by:
- Reviewing room and board billing practices
- Ensuring correct revenue code usage
- Reducing denials and write-offs
- Improving patient billing accuracy
Facing denials or disputes over private room charges?
Partner with NAHL for expert medical billing support that protects revenue and compliance. Contact NAHL today to fix private room billing before it becomes a liability.
