How to Use Revenue Code 0119 for Private Room Billing

Billing for private inpatient rooms may sound simple on the surface, but in reality, it is one of the most frequently misunderstood areas in hospital billing. The confusion becomes even greater when a patient does not fall under typical inpatient categories like medical/surgical, pediatrics, oncology, rehabilitation, psychiatry, or obstetrics.

That’s where Revenue Code 0119 comes into play a code designed to capture private room billing for patients who do not fit into any other private room classification.

Yet many billing teams misapply the code, forget payer-specific requirements, or submit claims without proper documentation, leading to denials or underpayments. With payer audits increasing by 19% in 2024, understanding how and when to use 0119 is more important than ever.

This guide is written specifically for hospital billers, RCM specialists, billing managers, and compliance teams who want to ensure accurate coding and complete reimbursement.

What Is Revenue Code 0119?

Revenue Code 0119 is part of the 011X series used to classify inpatient private room and board charges. It is defined as:

“Private room other, not classified in another category.”

In simpler terms, you use 0119 when:

• The patient is in a true private room (one bed), and
• No specific private room category fits the patient’s clinical situation, and
• Medical necessity for the private room is documented.

The 011X series includes:

0119 is often referred to as a “flex category” because it covers overflow cases, unique medical needs, and situations where the patient doesn’t belong in a specialty unit.

Why Revenue Code 0119 Matters in 2025

Recent national trends show a major shift in hospital room utilization:

2024–2025 National Hospital Room Trends

• 28% increase in isolation-based admissions due to infectious disease precautions
• 41% of private room denials were tied to incorrect or incomplete revenue code selection
• 53% of hospitals reported overflow admissions from specialty units
• 27% of private room denials were due to missing “medical necessity for private room” documentation
• Hospitals that corrected their private room revenue code usage saw an 18%–22% increase in accurate reimbursement

This clearly shows that understanding 0119 is no longer optional it’s essential for revenue integrity.

When Should You Use Revenue Code 0119?

Revenue Code 0119 applies when:

1. The patient is in a private room (single bed)

A two-bed room converted for temporary use does not qualify unless documented clearly by the facility.

2. No specialty revenue code describes the patient’s care

If the patient is not receiving OB, oncology, pediatric, psychiatric, detox, rehab, or hospice care, 0119 may be correct.

3. There is a documented medical reason for the private room

Payers will NOT reimburse for private rooms chosen for convenience.

4. The patient is receiving routine inpatient care not tied to a specific clinical program

This includes:

Infection control / isolation cases

Common examples:

• MRSA
• C. diff
• Isolation for immunocompromised status
• Suspected tuberculosis
• Contact/airborne precaution

Immune-compromised or high-risk patients

Such as:

• Severe neutropenia
• Post-transplant patients outside specialty units
• Patients needing reverse isolation

Safety-required private rooms

Example:

• Severe fall risk
• Behavioral instability outside psych units
• Patients requiring constant monitoring

Specialty unit overflow

This is extremely common today due to room shortages.

Example:

• Oncology unit full → neutropenic patient placed in medical private room
• Pediatric unit full → post-surgical patient placed in medical private room

Non-specialty inpatient stays requiring privacy

• Post-trauma observation
• Complex wound management
• Sensitive medical conditions where privacy is clinically required

These are all appropriate situations for 0119.

When You Should NOT Use Revenue Code 0119

Do NOT use 0119 if:

1. A specialty unit applies

If the patient is located in or receiving care aligned with:

• Hospice
• Oncology
• Rehab
• Psychiatry
• Detoxification
• Obstetrics
• Pediatrics

You must use the correct 011X code.

2. The private room is for the patient’s preference

Documented phrases like:

• Patient requested a private room
• Family prefers privacy will result in denials.

3. Payer requires a specific code based on diagnosis or unit

Some examples:

• Medicare requires 0115 for inpatient hospice
• Commercial payers may require 0116 for detox
• Behavioral payers require 0114 for psych Always check payer contracts and provider manuals.

4. There is no documented medical necessity

If nursing or provider notes do not justify the need for a private room, claims may be rejected—even if correct clinically.

The Most Important Part: Documentation Requirements

Documentation can make or break reimbursement for 0119.

To avoid denials, documentation MUST include:

• The reason the patient needed a private room
• Specific clinical risks or isolation requirements
• Confirmation that the room is a one-bed private room
• Notes consistent across Nursing Notes, Orders, and the Face Sheet
• Provider signature supporting the need for isolation or monitoring

Strong documentation examples:

• Patient placed in private room due to severe neutropenia (ANC 300). Requires reverse isolation.
• Airborne precautions initiated pending TB results. Private room medically necessary.
• Behavioral risk: patient requires private room to ensure safety and continuous monitoring.
• Pediatric unit full; patient placed in private room on medical floor until bed becomes available.

Weak documentation that will cause denials:

• Patient in private room.
• Room assigned based on availability.
• Family requested privacy.
• Preferred single room.

Payers want to see clinical justification, not convenience.

Real-World Examples of Correct Use of 0119

Example 1: Neutropenic patient outside oncology unit

• Condition: ANC = 400
• Needing reverse isolation
• Oncology unit at capacity

Correct code: 0119
(Non-specialty unit + medically necessary private room)

Example 2: Patient with possible TB

• Placed in airborne isolation
• Not a psych, pediatric, oncology, or rehab patient

Correct code: 0119

Example 3: Fall-risk patient needing continuous monitoring

• Placed in private room for safety
• No specialty program needed

Correct code: 0119

Example 4: Post-procedure observation

• No specialty unit
• Clinical need for observation and privacy

Correct code: 0119

Incorrect Use Examples (Denials)

Example 1: Patient requested a private room

Incorrect: 0119
Reason: No medical necessity.

Example 2: Oncology patient in an oncology unit

Incorrect: 0119
Correct code: 0117

Example 3: Psych patient placed in psych unit

Incorrect: 0119
Correct code: 0114

Example 4: Patient placed in private room due to convenience of staff

Incorrect: 0119

Updated Reimbursement Rates for Revenue Code 0119 (2025)

Key Insight:

There is an enormous range of variation—from $420 to over $27,000 depending on payer, contract, and medical necessity documentation.

How to Verify Your Hospital’s True Reimbursement

To know exactly what you are paid:

Check 835 Remittance Advices

Find payments tied to RC 0119.

Pull RCM or accounting reports

Sort RC 0119 by payer.

Compare allowed vs. actual paid amounts

Any underpayment triggers review.

Review payer contracts

Many hospitals miss revenue due to contract misunderstandings.

Use Revenue Integrity teams

They help correct payer discrepancies.

Why Hospitals Lose Money on Private Room Billing

Top reasons include:

1. Missing documentation

Most common reason for denials.

2. Wrong revenue code selection

41% of denials in 2024.

3. Misalignment between unit location and code

If the patient is on a specialty unit, 0119 is incorrect.

4. Payer-specific coding rules

Each payer may require a different 011X code depending on diagnosis.

5. Using 0119 for patient preference

Guaranteed denial.

How WeMedBill Helps Prevent 0119 Denials

At WeMedBill, we help hospitals avoid 0119-related denials through:

• Detailed clinical documentation review
• Revenue code validation
• Payer rule cross-checking
• Specialty and unit verification
• Automated alerts for incorrect room coding
• Monthly audits to prevent lost revenue

Our goal is to ensure every claim is clean, compliant, and fully reimbursed.

Final Summary

Revenue Code 0119 is essential for billing private inpatient room and board when the patient’s stay:

• Does not fit any specialty unit
• Requires a private room based on medical necessity
• Is properly documented
• Meets payer-specific requirements

Using 0119 incorrectly leads to denials, but using it correctly helps ensure hospitals get paid accurately for medically necessary care.

At WeMedBill, we help facilities decode payer rules, strengthen documentation, and eliminate costly mistakes in revenue code assignment.