skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Bill Type Codes

UB-04 Form Locator code lookup

The UB-04 form locator tool is designed to help facilities understand the definitions of the codes needed for claim submission. Click on the form locator headers for definitions to the codes used when filing the UB-04 claim to Medicare or enter the code in the search box and the definition will be returned.

The use of this tool does not guarantee payment. The information provided is informational only.

Bill Type Codes
011X Hospital Inpatient (Part A)
012X Hospital Inpatient Part B
013X Hospital Outpatient
014X Hospital Other Part B
018X Hospital Swing Bed
021X SNF Inpatient
022X SNF Inpatient Part B
023X SNF Outpatient
028X SNF Swing Bed
032X Home Health
034X Home Health (Part B Only)
041X Religious Nonmedical Health Care Institutions
043X Religious Nonmedical Health Care Institutions- Outpatient Services
065X Intermediate Care - Level I
066X Intermediate Care - Level II
071X Clinical Rural Health
072X Clinic ESRD
073X Federally Qualified Health Centers
074X Clinic - Outpatient Rehabilitation Facility (ORF)
075X Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
076X Community Mental Health Centers
081X Nonhospital based hospice
082X Hospital based hospice
083X Hospital Outpatient (ASC)
085X Critical Access Hospital

Type of bill frequency codes

frequency codes
0 Non-payment/zero
1 Admit through discharge claim
2 Interim - first claim
3 Interim - continuing claim
4 Interim - last claim
5 Late charge(s) only
7 Replacement of prior claim
8 Void/Cancel of prior claim
9 Final Claim for a home health PPS episode
A Admission/election notice
B Hospice/CMS Coordinated Care Demonstration/Religious Non-Medical Health Care Institution/Centers of Excellence Demonstration/Provider Partnerships Demonstration
C Hospice change of provider notice
D Hospice/CMS Coordinated Care Institution/Centers of Excellence Demonstration/Provider Partnerships Demonstration Void/Cancel
E Hospice change of ownership
F Beneficiary initiated adjustment claim
G CWF initiated adjustment claim
H CMS initiated adjustment
I Intermediary adjustment claim
J Initiated adjustment claim - other
K OIG initiated adjustment claim
M MSP initiated adjustment claim
O Nonpayment/zero claims
P QIO adjustment claim
Q Claim submitted for reconsideration/reopening outside of timely limits
X Void/Cancel a prior abbrev. Encounter submission
Y Replacement a prior abbrev. Encounter submission
Z New abbrev. encounter submission
Priority (Type) of Admission/Visit
1 Emergency
2 Urgent
3 Elective
4 Newborn
5 Trauma
6 Information not available
Point of Origin for Admission or Visit
1 Non-health care facility point of origin
2 Clinic or physician's office
4 Transfer from a hospital (different facility)
5 Transfer from a SNF, ICF or ALF
6 Transfer from another health care facility
8 Court/law enforcement
9 Information not available
G Transfer from a Designated Disaster Alternative Care Site
D Transfer from hospital inpatient in the same facility resulting in a separate claim to the payer
E Transfer from ASC
F Transfer from hospice facility
FL 17 - Patient Status
01 Discharged to home or self care (Routine discharge)
02 Discharged/transferred to a short-term general hospital for inpatient care
03 Discharged/transferred to SNF with Medicare certification in anticipation of Skilled Care
04 Discharged/transferred to a facility that provides custodial or supportive care
05 Discharged/transferred to a designated cancer center or children's hospital
06 Discharged/transferred to home/under HHA care in anticipation of covered skilled care
07 Left against medical advice or discontinued care
09 Admitted as inpatient to this hospital
21 Discharged/transferred to court/law enforcement
30 Still patient
40 Expired at home
41 Expired in medical facility
42 Expired place unknown
43 Discharged/transferred to federal health care facility
50 Hospice - home
51 Hospice - medical facility providing hospice level of care
61 Discharged/transferred to hospital-based Medicare approved swing bed
62 Discharged/transferred to IRF including rehab distinct part units of a hospital
63 Discharged/transferred to Medicare certified LTCH
64 Discharged/transferred to nursing facility certified under Medicaid but not under Medicare
65 Discharged/transferred to psychiatric hospital or psych dist part unit of a hospital
66 Discharged/transferred to a CAH
69 Discharged/transferred to a designated disaster alternative care site
70 Discharged/transferred to another type of health care institution not defined elsewhere in this code list
81 Discharged to home or self care with a planned acute care hospital inpatient readmission
82 Discharged/transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission
83 Discharged/transferred to a SNF with Medicare certification with a planned acute care hospital inpatient readmission
84 Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission
85 Discharged/transferred to a designated cancer center or children's hospital with a planned acute care hospital inpatient readmission
86 Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission
87 Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission
88 Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission
89 Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission
90 Discharged/transferred to an IRF including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission
91 Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission
92 Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission
93 Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital with a planned acute care hospital inpatient readmission
94 Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission
95 Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission.Ocurrence Code 55 also required
FL 18-28 - Condition Codes
01 Military service related
02 Condition is employment related
03 Patient covered by insurance not reflected here
04 Information only bill
05 Lien has been filed
06 ESRD 1st 30 mo. entitlement, covered by EGHP
07 Treatment of non-terminal condition - hospice
08 Would not provide other insurance info
09 Neither patient nor spouse is employed
10 Patient and/or spouse employed, no EGHP
11 Disabled beneficiary but no LGHP
17 Patient is homeless
18 Maiden name retained
19 Child retains mother's name
20 Beneficiary requested billing
21 Billing for denial notice
22 Patient on multiple drug regimen
23 Home care giver available
24 Home IV patient receiving home health services
25 Patient is a non-U.S. resident
26 VA patient chooses Medicare facility
27 Patient referred to sole community hospital for diagnostic lab test
28 Patient/spouse EGHP secondary to Medicare
29 Disabled bene/fam LGHP secondary to Medicare
30 Qualifying clinical trials
31 Patient is a student, full-time
32 Patient is a student, coop/work-study prog
33 Patient is a student, full-time - night
34 Patient is a student, part-time
36 General care patient in special unit
37 Ward accommodation at patient request
38 Semi-private room not available
39 Private room medically necessary
40 Same day transfer
41 Partial hospitalization
42 Continue care plan not related to inpat hospitalization
43 Continue care, not within prescribed post-discharge window
44 Inpatient admission changed to outpatient
45 Ambiguous gender category
46 Non-availability statement on file
47 Transfer from another home health
48 Psychiatric residential treatment centers for children and adolescents
49 Product replacement within product lifecycle
50 Product replacement for known recall of a product
51 Attestation of unrelated outpatient non-diagnostic services
52 Out of hospice service area
53 Initial placement of a medical device provided as part of a clinical trial or a free sample
54 No skilled home health visits in billing period
55 SNF bed not available
56 Medical appropriateness
57 SNF readmission
58 Terminated Medicare Advantage enrollee
59 Non-primary ESRD facility
60 Day outlier
61 Cost outlier
66 Provider does not wish cost outlier payment
67 Beneficiary elects not to use LTR days
68 Beneficiary elects to use LTR days
69 IME/DGME/N&AH payment only
70 Self-administered anemia mgmt. drug
71 Full care in unit (dialysis)
72 Self care in unit (dialysis)
73 Self care training (dialysis)
74 Home dialysis
75 Home dialysis - 100% reimbursement
76 Back-up in facility dialysis
77 Provider accepts as payment in full
78 New coverage not implemented by managed care plan
79 CORF services provided offsite
80 Home Dialysis - nursing facility
81 C-Sections/Inductions < 39 weeks - medical necessity
82 C-Sections/Inductions < 39 weeks - elective
83 C-Sections/Inductions 39 weeks or greater
84 Dialysis for acute kidney injury
85 Delayed recertification of hospice terminal illness
86 Additional hemodialysis treatments with medical justification
A0 TRICARE external partnership prog
A2 Physically handicapped children's prog
A3 Special federal funding
A4 Family planning
A5 Disability
A6 Vaccines/Medicare 100% payment
A9 Second opinion surgery
AA Abortion - rape
AB Abortion - incest
AC Abortion - genetic defect
AD Abortion - life endangering condition
AE Abortion - not life endangering
AF Abortion - emotional health
AG Abortion - social/economic Reasons
AH Elective abortion
AI Sterilization
AJ Payer responsible for co-payment
AK Air ambulance required
AL Specialized treatment/bed unavailable
AM Non-emergency medically necessary stretcher transport required
AN Pre admission screening not required
B0 Medicare coord. care demo claim
B1 Beneficiary is ineligible for demo prog
B2 CAH ambulance attestation
B3 Pregnancy indicator
B4 Admission unrelated to discharge on same day
BP Gulf oil spill of 2010
C1 Approved as billed (QIO)
C2 Automatic approval on focused review (QIO)
C3 Partial approval (QIO)
C4 Admission/services denied (QIO)
C5 Post-payment review applicable (QIO)
C6 Admission preauthorization (QIO)
C7 Extended authorization (QIO)
D0 Changes to service dates
D1 Changes to charges
D2 Changes to revenue codes/HCPCS/HIPPS rate codes
D3 Second or subsequent interim PPS bill
D4 Change in ICD procedure codes
D5 Cancel to correct insured's/provider ID
D6 Cancel only to repay dup or OIG overpayment
D7 Medicare as secondary
D8 Medicare as primary
D9 Other changes
DR Disaster related
E0 Change in patient status
G0 Distinct medical visit
H0 Delayed filing: statement of intent submitted
H2 Discharge by a hospice provider for cause
H3 Reoccurrence of GI bleed comorbid
H4 Reoccurrence of Pneumonia comorbid
H5 Reoccurrence of Pericarditis comorbid
P1 Do not resuscitate order (DNR)
P7 Direct inpat admission from ED
R1 Request for reopening - math or computational mistakes
R2 Request for reopening - inaccurate data entry
R3 Request for reopening - misapplication of a fee schedule
R4 Request for reopening - computer errors
R5 Request for reopening - incorrectly identified dup claim
R6 Request for reopening - other clerical and minor errors and omissions
R7 Request for reopening - corrections other than clerical errors
R8 Request for reopening - new and material evidence
R9 Request for reopening - faulty evidence
W0 UMWA demonstration indicator
W2 Duplicate of original bill
W3 Level I appeal
W4 Level II appeal
W5 Level III appeal
FL 31-34 - Occurrence Codes
01 Accident/medical coverage
02 No-fault insurance, including auto
03 Accident, tort liability
04 Accident, employment-related
05 Accident/no medical or liability cov
06 Crime victim
09 Start of infertility treatment
10 Last menstrual period
11 Onset of symptoms/illness
12 Date of onset, chronically dependent individual
16 Date of last therapy
17 Date outpatient occupational therapy plan established/last reviewed
18 Date of retirement (patient/bene)
19 Date of retirement (spouse)
20 Date guarantee of payment began
21 Date UR notice received
22 Date active care ended
24 Date insurance denied
25 Date benefits terminated by primary payer
26 Date SNF bed available
27 Date hospice cert or recert
28 Date CORF plan estab/last reviewed
29 Date outpatient physical therapy plan estab/last reviewed
30 Date outpatient speech language pathology plan estab/last reviewed
31 Date bene notified intent to bill (accom)
32 Date bene notified intent to bill (proc/treat)
33 First day of ESRD coordination covered by EGHP
34 Date of election of extended care
35 Date physical therapy started
36 Date inp hosp disch, covered transplant
37 Date inp hosp disch, non-covered transplant
38 Date started for home IV therapy
39 Date disch/on a cont/course of IV therapy
40 Scheduled date of admission
41 Date of first test/pre-admission testing
42 Date of discharge
43 Scheduled date of canceled surgery
44 Date occupational therapy started
45 Date speech therapy started
46 Date cardiac rehab started
47 First full day of cost outlier
50 Assessment date
51 Date of last Kt/V reading
52 Medical certification/recert date
54 Physician follow-up date
55 Date of Death
A1 Birth date, insured A
A2 Effective date, insured A policy
A3 Benefits exhausted - Payer A
A4 Split bill date
FL 35-36 - Occurrence Span Codes
70 Qualifying stay dates for SNF only
71 Prior stay dates
72 First/last visit dates
73 Benefit eligibility period
74 Noncovered level of care or leave of absence (LOA)
75 SNF level of care dates
76 Patient liability period
77 Provider liability period
78 SNF prior stay dates
80 Prior same-SNF stay dates for payment ban purposes
81 Antepartum Days at Reduced Level of Care
M0 QIO/UR approved stay dates
M1 Provider liability - no utilization
M2 Inpatient respite dates
M3 ICF level of care
M4 Residential level of care
FL 39-41 - Value Codes
01 Most commom semi-private rate
02 Hospital has no semi-private rooms
04 Professional component charges, combined billed
05 Professional component included, billed to carrier
06 Blood deductible
08 LTR amount, 1st calendar year
09 Co-ins amount, 1st calendar year
10 LTR amount, 2nd calendar year
11 Co-ins amount, 2nd calendar year
12 Working aged bene/spouse with EGHP
13 ESRD bene in Medicare coord period with EGHP
14 No-fault, including auto/other ins
15 Worker's compensation
16 PHS or other federal agency
21 Catastrophic
22 Surplus
23 Recurring monthly income
24 Medicaid rate code
25 Offset to pt-pymnt amnt - RX drugs
26 Offset to pt-pymnt amnt - hearing & ear
27 Offset to pt-pymnt amnt - vision & eye
28 Offset to pt-pymnt amnt - dental services
29 Offset to pt-pymnt amnt - chiropractic
30 Pre-admission testing
31 Patient liability amount
32 Multiple patient ambulance transport
33 Offset to pt-pymnt amnt - podiatric
34 Offset to pt-pymnt amnt - other medical
35 Offset to pt-pymnt amnt - health ins. Prem
37 Units of blood furnished
38 Blood deductible units
39 Units of blood replaced
40 New coverage not implemented by HMO
41 Black lung
42 VA
43 Disabled bene under 65 with LGHP
44 Amount provider agreed to accept from primary payer
45 Accident hour
46 Number of grace days
47 Any liability insurance
48 Hemoglobin reading
49 Hematocrit reading
50 Physical therapy visits
51 Occupational therapy visits
52 Speech therapy visits
53 Cardiac rehab visits
54 Newborn birth weight in grams
55 Eligibility threshold for charity care
56 Skilled nursing visits hours (HHA)
57 HH aide, home visit hours (HHA)
58 Arterial blood gas
59 Oxygen saturation
60 HHA branch MSA
61 Arterial blood gas
66 Medicaid spend down amount
67 Peritoneal dialysis (HHA)
68 EPO - drug
69 State charity care percent
80 Covered days
81 Non-covered days
82 Co-insurance days
83 Lifetime reserve days
84 Shorter duration, hemodialysis (Effective 7/1/17)
A0 Special ZIP code reporting
A1 Deductible, payer A
A2 Co-insurance, payer A
A3 Estimated responsibility, payer A
A4 Cvrd self-administrable drugs/emergency
A Cvrd self-administrable drugs - not self administrable form/situation
A6 Cvrd self-administrable drugs - study
A7 Co-payment payer A
A8 Patient weight
A9 Patient height
AA Regulatory surcharges, assessments, allowances or health care related taxes payer A
AB Other assessments or allowances (e.g., medical education) payer A
Use B1-GB as A1-A3 and A7-AB for other payers
Y1 Part A demonstration payment
Y2 Part B demonstration payment
Y3 Part B coinsurance
Y4 Conventional provider payment
Y5 Part B deductible
FL 59 - Patient Relationship to Insured
01 Spouse
18 Self
19 Child
20 Employee
21 Unknown
39 Organ donor
40 Cadaver donor
53 Life partner
GS Other relationship
Revenue Codes
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.