Revenue Code 0360: Complete Guide to Operating Room Billing
Quick Summary
Revenue Code 0360 represents hospital facility charges for surgeries performed in the main operating room. It reflects OR-level resources such as equipment, staff, and infrastructure—not physician services. Correct use requires alignment with documentation, CPT codes, and payer-specific rules to avoid denials and underpayment.
When a hospital submits a claim, every charge must tell a clear story about the services provided. One of the most important parts of that story is the revenue code—an institutional billing code that explains what type of facility resources were used during a patient’s care. Among these codes, 0360 plays a central role because it represents the use of the hospital’s main operating room.
Operating rooms are some of the most resource-intensive areas within a hospital. From specialized equipment to trained surgical staff, the facility invests heavily every time surgery takes place. Revenue Code 0360 helps communicate this level of service to the payer so reimbursement can be calculated accurately and claims are processed without delays.
In this guide, we break down exactly what 0360 means, when it should be used, how it differs from other codes in the same series, and what hospitals must do to document it correctly. Whether you’re a coder, a biller, or a facility administrator, this section-by-section breakdown will help you avoid common mistakes, reduce denials, and strengthen your revenue cycle for operating room services
Blog Outline
- What Is Revenue Code 0360?
- What Revenue Code 0360 Covers
- When to Use Revenue Code 0360
- What Revenue Code 0360 Does NOT Cover
- Revenue Code 0360 vs Related 036X Codes
- Common CPT Codes Paired With Revenue Code 0360
- Accurate Billing Guidelines for Revenue Code 0360
- Documentation Checklist for Revenue Code 0360
- Reimbursement for Operating Room Facility Charges
- Common Denials Related to Operating Room Facility Charges (and How to Fix Them)
- State & Payer-Specific Rules for Operating Room Billing
- Conclusion
- FAQs About Operating Room Revenue Codes
What Is Revenue Code 0360?
Revenue Code 0360 is the hospital’s way of indicating that a patient received services in the main operating room. On the UB-04 claim form, this four-digit code represents the facility’s operating room resources—not the surgeon’s professional services, but the hospital’s side of the surgery. It signals to the payer that the procedure required a fully equipped surgical environment, specialized staff, sterile supplies, and the infrastructure of a formal operating suite.
Unlike professional billing, where CPT or HCPCS codes describe what procedure the surgeon performed, revenue codes describe where and what type of facility resources were used. Revenue Code 0360 specifically reflects that the service occurred in the primary operating room rather than in a minor procedure room, bedside setting, or specialty transplant suite.
Hospitals use this code for inpatient and outpatient surgeries when the work takes place in a full-service operating room and no more specific revenue code in the 036X family applies. By assigning 0360, the facility communicates the intensity and cost structure associated with using the OR—information payers rely on when determining reimbursement under APCs, DRGs, or contract-based payment methods.
In short, Revenue Code 0360 tells the payer: “This service used the hospital’s operating room resources.”
What Revenue Code 0360 Covers
Revenue Code 0360 represents the facility resources required to perform surgery in a hospital’s main operating room. It includes:
Operating room time from patient entry to exit
OR nursing and technical staff, including circulating nurses and scrub techs
OR-grade equipment and infrastructure, such as surgical lights, tables, anesthesia machines, and monitoring systems
Sterile environment and support services, including airflow control and sterilization
These elements communicate to the payer that the procedure required a full-service operating suite rather than a minor procedure room or bedside setting.
0360 establishes the facility intensity level for the payer. It communicates that the setting was more complex than a procedure room or bedside surgery, which affects reimbursement methodologies such as APCs, DRGs, or percentage-of-charge contracts.
In other words, Revenue Code 0360 tells the insurer that the hospital committed the full resources of a surgical suite—equipment, staff, environment, and overhead—to support the procedure
When Revenue Code 0360 Is Appropriate
Use Revenue Code 0360 When:
Surgery occurs in the main operating room
OR-level staff, equipment, and anesthesia support are used
The CPT/HCPCS code represents a true surgical procedure
No more specific 036X code applies
Use Revenue Code 0360 only when the hospital performed a surgery in the main operating room, used OR-level resources, and no specialty revenue code in the 036X series better describes the service. Correct selection ensures accurate reimbursement and prevents avoidable claim rejections.
What Revenue Code 0360 Does NOT Cover
Do NOT Use Revenue Code 0360 For:
Surgeon or anesthesia professional fees
Minor procedures performed in treatment rooms or at bedside
Transplant surgeries (0362–0369 apply)
PACU or recovery room services
Implants, biologics, or high-cost supplies billed separately
Pre-op or post-op care outside the OR
Revenue Code 0360 is specific to facility-level operating room services. Anything that falls under professional billing, postoperative recovery, transplant-specific environments, minor procedures, supplies, or diagnostics must be billed separately. Clear separation of these services ensures accurate reimbursement, reduces billing errors, and protects the claim from preventable denials
Revenue Code 0360 vs Related 036X Codes
Revenue Code 0360 belongs to a broader family of operating room revenue codes known as the 036X series. Each code in this group represents a specific type of surgical environment or resource category. Choosing the correct one is essential because it tells the payer exactly what type of operating room service the hospital provided.
Using a general code when a more specific option applies can cause the claim to be reclassified, delayed, or even denied. The table below simplifies the differences and helps you select the most accurate revenue code for your surgical cases.
Comparison of Revenue Codes in the 036X Series
| Revenue Code | Description | When to Use It |
|---|---|---|
| 0360 | Operating Room Services – General Classification | When the surgery occurs in the main OR and does not fit a more specific category. |
| 0361 | Minor Surgery | For procedures performed in a minor OR, treatment room, or bedside—less complex than full OR surgeries. |
| 0362 | Organ Transplant | For transplant surgeries that require specialized transplant OR resources. Use for general transplant procedures unless a more specific code exists. |
| 0367 | Kidney Transplant | When the surgery involves kidney transplantation and is performed in a transplant-designated operating environment. |
| 0368 | Liver Transplant | Reserved for liver transplant surgeries conducted in liver-specific transplant OR units. |
| 0369 | Other Transplants | For other types of transplants such as heart, lung, pancreas, or multi-organ procedures. |
Each revenue code in this series communicates different levels of complexity, staffing requirements, equipment needs, and operational cost. For example:
- Minor surgery rooms do not require the same sterile airflow systems or OR infrastructure as full operating rooms.
- Transplant ORs require highly specialized environments, immunologic controls, and dedicated staff.
- General OR services (0360) apply only when the surgery takes place in the hospital’s full-service operating theater without falling into a specialty category.
Selecting the correct code ensures:
- Accurate reimbursement
- Reduced payer rejections
- Cleaner claim audits
- Appropriate alignment with the CPT/HCPCS procedure codes
Even small misclassifications can lead to compliance concerns or reduced payment, especially for high-cost surgeries.
Where Coders Often Make Mistakes
Some of the most common errors include:
- Using 0360 for minor procedures performed in treatment rooms
- Selecting 0360 for transplant surgeries that belong under 0362–0369
- Pairing 0361 with CPT codes that clearly require a full-service operating room
- Forgetting to update the revenue code when the procedure complexity changes intraoperatively
These errors are avoidable with strong documentation and careful code selection
Common CPT Codes Paired With Revenue Code 0360
Common general surgery procedures paired with Revenue Code 0360 include laparoscopic appendectomy (44970), cholecystectomy (47562), colectomy (44140), and inguinal hernia repair (49505). These procedures require full OR resources, anesthesia support, and sterile environments.
General Surgery (Common OR Procedures)
These surgeries generally require a full OR setup, anesthesia support, and sterile equipment—making them appropriate for 0360.
- 44970 – Laparoscopic appendectomy
- 47562 – Laparoscopic cholecystectomy
- 49505 – Inguinal hernia repair
- 47379 – Liver surgical procedures (unlisted)
- 44140 – Colectomy
General surgery procedures are among the most frequently paired with 0360 in both inpatient and outpatient settings.
Orthopedic Surgery
Orthopedic procedures almost always require OR-level equipment, implants, and specialized surgical teams.
- 29881 – Knee arthroscopy with meniscectomy
- 27447 – Total knee arthroplasty
- 27130 – Total hip replacement
- 29826 – Shoulder arthroscopy with decompression
- 27506 – Open treatment of femur fracture
These cases often involve implants or hardware, which are billed separately under implant revenue codes—not included in 0360.
Gynecologic Surgery
OR-level gynecologic surgery frequently pairs with 0360 on outpatient hospital claims.
- 58571 – Laparoscopic hysterectomy
- 58661 – Laparoscopic salpingectomy or oophorectomy
- 58150 – Abdominal hysterectomy
- 57425 – Laparoscopic colpopexy
- 58940 – Ovarian cystectomy
These procedures typically require anesthesia services, surgical teams, and full OR instrumentation.
Urology
Most urologic surgeries that involve scopes, lasers, or invasive repairs qualify for 0360.
- 52356 – Ureteroscopy with lithotripsy
- 55866 – Robotic-assisted prostatectomy
- 50080 – Percutaneous nephrostolithotomy
- 52601 – TURP (prostate resection)
- 50590 – Kidney stone lithotripsy (OR version)
Some urologic procedures can occur in minor surgery rooms, but those requiring full OR resources align with 0360.
ENT (Otolaryngology)
ENT procedures vary in complexity; the ones below typically fall under main OR use.
- 42820 – Tonsillectomy and adenoidectomy
- 30140 – Submucous resection, nasal septum
- 31365 – Laryngoscopy with biopsy
- 30520 – Septoplasty
- 31267 – Ethmoidectomy
ENT surgeries often require specialized positioning equipment and anesthesia, supporting 0360 use.
Neurosurgery
Neurosurgical procedures are consistently billed under full OR revenue codes due to complexity.
- 63047 – Lumbar laminectomy
- 61510 – Craniotomy
- 22842 – Spinal instrumentation
- 62270 – Spinal tap (OR-based cases only)
- 61783 – Stereotactic computer-assisted navigation
These procedures demand advanced OR monitoring systems, neuromonitoring, and highly trained teams.
Cardiovascular Surgery
Surgeries involving the heart, vessels, or complex devices always require a main operating room.
- 33533 – Coronary artery bypass grafting
- 35301 – Carotid endarterectomy
- 33228 – Pacemaker removal and replacement (OR-based)
- 35371 – Femoral artery repair
- 33883 – Thoracic aortic endovascular repair
These procedures also frequently involve implants, billed separately.
Adding CPT examples clarifies:
- medical necessity for OR use
- correct pairing of professional and facility billing
- alignment between documentation, revenue codes, and procedure codes
- reduced risk of mismatched claims
This level of detail helps coders, auditors, and billers understand exactly how 0360 is used in real clinical situations
Accurate Billing Guidelines for Revenue Code 0360
Correctly billing Revenue Code 0360 requires more than simply knowing that a surgery took place in the main operating room. Payers expect alignment between documentation, OR charges, procedure codes, and the facility’s chargemaster. Missing even one element can create delays, rejections, or reduced reimbursement.
Below is a clear, step-by-step workflow to ensure Revenue Code 0360 is billed accurately and consistently.
1. Verify That the Procedure Took Place in the Main Operating Room
Before assigning 0360, confirm:
- The patient entered a fully equipped operating suite
- OR-level equipment and staff were used
- The procedure could not be appropriately billed under a minor surgery or specialty revenue code (0361, 0362–0369)
If the setting doesn’t match the main OR environment, using 0360 may be considered incorrect classification.
2. Confirm the Procedure Code Aligns With OR-Level Services
Revenue codes and CPT/HCPCS codes must tell the same story.
The CPT code should represent a surgical procedure that:
- requires anesthesia support
- involves sterile technique
- needs OR-grade instruments
- cannot be performed safely in a minor procedure room
Pairing 0360 with a non-surgical or bedside-level CPT code nearly always triggers payer scrutiny.
3. Review Documentation for OR Start and Stop Times
Accurate OR time is essential because it directly influences facility charges.
Documentation should clearly show:
- patient entry into the OR
- surgical start and stop times
- time spent closing, prepping, and transitioning
- exit from the OR to PACU
Inconsistencies between time logs and charges are a frequent source of denials.
4. Capture OR-Level Resources and Supplies Correctly
The billing team must ensure that OR resource use matches the coded service.
0360 covers:
- circulating and scrub staff
- anesthesia equipment (facility component)
- OR lights, tables, and monitoring
- general OR supplies
It does not cover:
- implants
- high-cost devices
- separately billable medications
- PACU services
These should be billed under their respective revenue codes.
5. Check for Specialty Requirements or Contract Rules
Some payers have unique rules tied to OR billing, such as:
- minimum OR time thresholds
- bundling requirements for anesthesia
- separate lines for implants or biologics
- APC-level grouping for outpatient cases
- DRG-based reimbursement for inpatients
Always verify state Medicaid rules, Medicare OPPS guidelines, and private payer contracts.
6. Ensure Consistency on the UB-04 Claim Form
On the UB-04:
- Enter 0360 in the revenue code field
- Pair it with the appropriate CPT/HCPCS code
- Include total OR charges from the chargemaster
- Avoid duplicate or overlapping charges
Every element of the claim should support the use of 0360.
7. Audit the Claim Before Submission
A final review helps catch issues that cause delays.
Your audit checklist should confirm:
- the location of service matches 0360
- OR time is consistent with the operative note
- the procedure code justifies an OR environment
- transplant or minor surgery codes weren’t overlooked
- no unrelated charges were bundled into 0360
- all documentation is complete and legible
This last step protects against preventable denials and ensures clean claims.
0360 is a high-value revenue code.
Because OR time is expensive and heavily scrutinized, payers expect the coding, documentation, and clinical data to align perfectly. Proper billing safeguards reimbursement, reduces administrative burden, and protects compliance
Documentation Checklist for Revenue Code 0360
Accurate documentation is the backbone of correct OR billing. Revenue Code 0360 represents one of the costliest parts of hospital operations, so payers closely review the records that support it. When documentation is incomplete, inconsistent, or unclear, claims are often delayed, downcoded, or denied altogether. This checklist ensures your clinical and billing teams capture everything needed to justify the use of the main operating room and secure compliant reimbursement.
✔ Operative Report (Full Surgical Details)
✔ OR Start and Stop Times
✔ Location of Service (Main Operating Room Confirmation)
✔ OR Staffing Documentation
✔ Equipment and Resources Used
✔ Anesthesia Documentation (Facility Portion)
✔ Supplies and Consumables Used During Surgery
✔ Medical Necessity for OR-Level Surgery
✔ Physician Orders and Pre-Operative Notes
✔ Post-Operative Documentation (Non-PACU overlap)
Reimbursement for Operating Room Facility Charges
Payment for operating room facility services varies widely because each payer uses its own methodology. Instead of a single fixed rate, reimbursement depends on how the insurer evaluates the procedure, the hospital’s contract terms, and whether the patient was treated on an inpatient or outpatient basis.
Below is a clear breakdown of how payers typically calculate payment for this type of operating-room charge.
1. Medicare Outpatient Claims (APC-Based Payment)
For outpatient surgeries, Medicare uses the Ambulatory Payment Classification (APC) system.
The CPT or HCPCS code assigned to the surgical procedure determines which APC group it falls into. The facility’s OR revenue line (0360) helps confirm that the setting was a full operating room, but the APC rate—not the OR code itself—drives payment.
Key points:
- Payment is packaged into the APC for the primary procedure
- Some services or supplies may be separately payable
- The OR revenue line supports medical necessity and appropriate grouping
2. Medicare Inpatient Claims (DRG-Based Payment)
For inpatient surgeries, Medicare pays through Diagnosis-Related Groups (DRGs).
The surgical DRG already includes the costs associated with using the operating room.
This means:
- The OR revenue line supports the DRG assignment
- Payment is fixed per DRG, regardless of actual OR time
- Proper documentation helps prevent DRG downgrades
3. Medicaid Programs (Varies by State)
State Medicaid programs set their own rules.
Some use:
- APC-like systems
- Per-diem models
- Percentage-of-charge arrangements
- Fixed-fee outpatient surgical schedules
Because every state differs, hospitals must check their specific Medicaid manual for guidance.
4. Commercial Insurance Contracts
Private payers tend to negotiate contracts individually with hospitals, so reimbursement varies dramatically.
Common approaches include:
- Percent-of-charge contracts (e.g., 30% of billed charges)
- Fixed case rates for certain procedures
- Outpatient surgical grouper methodologies
- Bundled payment models for high-volume surgeries
With commercial plans, accurate classification of the service as main-OR usage is crucial because it impacts the payment tier.
Knowing how payers evaluate OR services helps hospitals:
- predict financial outcomes
- avoid underbilling
- justify medical necessity
- reduce payment delays
- ensure contract compliance
When the procedure code, documentation, and OR setting all align, payers can determine reimbursement quickly and accurately—regardless of whether the patient was under APC, DRG, or commercial pricing rules
Common Denials Related to Operating Room Facility Charges (and How to Fix Them)
Operating room billing is one of the most closely audited areas in hospital claims. Because these charges represent high-cost services, payers review them for accuracy, medical necessity, and alignment with the procedure performed. When even small details are missing or inconsistent, denials happen.
Below are the most frequent denial reasons tied to main OR charges—and the steps facilities can take to prevent or correct them.
1. Mismatch Between Procedure Code and Facility Setting
Why it Happens
The CPT or HCPCS code does not support the use of a full operating room.
Examples include minor procedures billed as if they required OR-level resources.
How to fix it
- Confirm the procedure truly required a main OR rather than a minor procedure suite.
- Ensure documentation reflects OR-level equipment, staffing, and anesthesia use.
- Reassign the correct revenue code (often 0361 for minor surgery) if needed.
2. Missing or Incomplete OR Start/Stop Times
Why it Happens
Time logs are unclear, missing, or conflicting with the operative report.
How to fix it
- Require anesthesia and nursing teams to document time entries consistently.
- Use OR management systems that capture timestamps electronically.
- Add an internal audit step before claim submission.
3. Documentation Does Not Support OR-Level Services
Why it Happens
The record doesn’t clearly show that full operating-room resources were used.
How to fix it
- Ensure the operative note includes the setting, equipment used, and staffing.
- Confirm the room number or suite designation appears in the chart.
- Add missing elements through proper physician addendums when allowed.
4. Wrong Revenue Code Selected Within the 036X Series
Why it Happens
Transplant cases or minor procedures are accidentally billed under the general OR category.
How to fix it
- Review 0362–0369 for transplant-related surgeries.
- Use 0361 for minor procedures.
- Provide education to coding teams on choosing the most specific code available.
5. Charges Not Aligned With the Procedure or Documentation
Why it Happens
The facility may bill OR time or supplies that don’t match what is documented.
Common payer flags include:
- unusually long OR time
- supplies unrelated to the procedure
- equipment charges not mentioned in the operative note
How to fix it
- Compare OR logs with the detailed procedure report.
- Validate billed items against the supplies actually used.
- Remove or correct any inconsistencies before submission.
6. Missing Medical Necessity Support
Why it Happens
The clinical notes do not fully explain why surgery was needed or why it required a main OR.
How to fix it
- Ensure pre-op notes, diagnostic results, and surgeon documentation clearly state the indication for surgery.
- Include imaging or lab findings when relevant.
- Strengthen medical necessity language in the operative report.
7. Incorrect Pairing With Anesthesia Billing
Why it Happens
Facility anesthesia support is not aligned with professional anesthesia codes.
How to fix it
- Ensure anesthesia start/stop times match between teams.
- Confirm anesthesia method matches the documented procedure.
- Review anesthesia logs for accuracy and completeness.
8. Payer-Specific Billing Rules Not Followed
Why it Happens
Some insurers require:
- dedicated lines for implants
- separate reporting of certain supplies
- minimum OR time thresholds
- unique modifiers or condition codes
Failure to meet these requirements leads to denials.
How to fix it
- Maintain payer-specific cheat sheets for OR billing.
- Train staff on commercial payer nuances.
- Always cross-check against contract appendices.
Fixing these issues proactively results in:
- faster reimbursement
- fewer appeals
- reduced administrative burden
- stronger compliance
- more predictable cash flow
- fewer takebacks during audits
High-cost surgical claims depend on precise alignment between documentation, billing processes, and payer rules. A clean OR claim starts long before the bill is generated—it begins with accurate charting and strong internal controls
State & Payer-Specific Rules for Operating Room Billing
Operating room billing rules are not uniform across payers. While core OR billing principles apply nationwide, reimbursement methods, documentation requirements, and bundling rules vary by payer type and state. Hospitals must align claims with payer-specific policies to avoid denials and underpayment.
Medicare (National Standards, Local Enforcement)
Medicare uses national guidelines, but Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs) issued by MACs can influence OR billing.
Key Medicare factors:
- Outpatient cases are paid under OPPS/APCs
- Inpatient cases fall under DRGs
- Some procedures require medically necessary documentation specific to the MAC
- Observation vs. inpatient status can affect how OR services are bundled
- Certain supplies may be “packaged” and not separately reimbursable
Hospitals should check the applicable MAC (e.g., Novitas, Palmetto, NGS) for procedure-specific rules.
Medicaid (Rules Vary by State)
Medicaid is one of the most variable payers when it comes to operating room billing. Each state publishes its own:
- billing guidelines
- covered procedure lists
- outpatient surgical payment methods
- documentation requirements
- implant billing policies
- facility fee limitations
Examples of variability:
- California (Medi-Cal): often uses fixed reimbursement tiers for outpatient surgery.
- Texas: may require separate reporting of certain OR supplies.
- Florida: uses unique packaging rules for hospital outpatient services.
- New York: has specific medical necessity criteria for certain surgeries.
Because state Medicaid programs frequently update their guidelines, hospitals should verify OR-related rules at least quarterly.
Commercial Insurance (Contract-Driven Differences)
Private payers often have the most diverse requirements because each hospital negotiates its own agreement. Differences may include:
- percent-of-charge contracts
- case rates for specific surgeries
- proprietary outpatient surgical groupers
- bundled payment programs
Some commercial payers may require:
- a dedicated line item for implants
- reporting of separate OR time units
- documentation of equipment used
- minimum minutes in the operating room for certain procedures
- preauthorization for specific surgeries
Failing to follow payer-specific nuances is one of the most common causes of operating-room denials in commercial claims.
Workers’ Compensation
Workers’ compensation insurers often impose:
- strict preauthorization requirements
- enhanced medical necessity reviews
- specific pricing schedules
- separate rules for surgical implants
- caps on reimbursable OR time
Because these claims can be highly regulated, documentation must be meticulous.
Operating room services are among the highest-cost and highest-risk claim categories. Understanding payer-specific and state-specific rules ensures:
- cleaner claims
- faster processing
- fewer back-and-forth requests
- accurate reimbursement
- better compliance across all payers
Hospitals that track these differences reduce costly denials, avoid takebacks, and improve their revenue cycle performance
Conclusion
Accurate billing for operating room services requires more than selecting the correct revenue line on a claim. It depends on understanding the surgical setting, maintaining clear documentation, pairing appropriate procedure codes, and following payer-specific billing rules. Because the operating room is one of the most resource-intensive areas of a hospital, the revenue classification used plays a critical role in communicating the level of facility support involved.
When documentation clearly supports the service performed and coding aligns with the clinical record, claims are processed more efficiently and paid predictably. When details are missing or the wrong classification is used, denials and delays are far more likely.
This guide outlines how to apply the general operating room classification correctly, what it includes, what it excludes, and how to avoid common billing errors. With consistent workflows and accurate documentation, hospitals can reduce administrative burden, strengthen compliance, and support reliable reimbursement for surgical services.
