ub-04 condition code list

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ub-04 condition code list

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CMS Manual System

UB-04 only value codes: 80 – Covered days (the number of days covered by the
primary payer as qualified by the payer). 81 – Non-Covered Days (days of care …

Medicare Claims Processing Manual Crosswalk – CMS

(NUBC) maintains lists of approved coding for the form. Medicare Administrative
…. FL35 Occurrence Span Code/From/Through a AN/N/N 2/6/6. 1/1/1.

CMS Manual System

Oct 5, 2009 … B. Policy: Field Locator 17 of the UB-04 and its electronic equivalence is a
required field on all … status code 21 in the list of codes allowed in a same day ….
FLs 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28 – Condition Codes …

CMS Manual System

manual to add existing provider range 4900 – 4999 in the list of applicable
provider … restructuring, the NUBC designated revenue code 0910 as “Reserved
for …. services provided on same day except claims containing condition codes
20, …

ub-04 claim form instructions – eohhs – RI.gov

Sep 16, 2016 … UB-04 CLAIM FORM INSTRUCTIONS. FIELD. NUMBER … 4. Type of Bill. Enter
the four digit code that identifies the specific type …. Occurrence Codes and.
Dates … List applicable NDC if field 44 is a J code which requires an …

UB-04 Claim filing instructions, Outpatient Hospital, Hospital Billing …

an electronic version of the UB-04 claim form for outpatient services are … 18-24.
** Condition Codes. Enter the applicable two-character condition code.

Hospital UB-04 Claim filing instructions, Section 2 Billing Book

The requirements for filing an electronic version of the UB-04 claim form for
inpatient services are slightly …. 18*-24*Condition Codes (continued) A1-Healthy
Children & Youth/EPSDT … List appropriate accommodation revenue codes first
in …

UB-04 Desk Reference

PA PROMISe™. Provider Handbook. 837 Institutional/UB-04 Claim Form. UB-04
Desk Reference for Hospitals … Condition Codes. (Form Locators 18–28).

Technical Assistance Conference Call – HRSA

All RHC billing is on the UB04 form. ✓ There are … FL 31 – 34 = Occurrence code
& date = situational but normally … codes are appropriate as primary codes; list.

OWCP-04 – United States Department of Labor

71 PPS. CODE. QUAL. LAST. LAST. National Uniform. Billing Committee. NUBC
™ … OWCP uses a condition-specific fee schedule based on the Prospective.

471-000-71 appendix – Nebraska Department of Health and Human …

These instructions can be used in combination with the CMS-1450 (UB-04) claim
form … Use Occurrence Span Code 70 to report nursing facility Medicare Days.

ND Health Enterprise MMIS UB-04 Claim Form Instructions

Sep 1, 2016 … UB-04 Claim Form Instructions …. Condition Codes: Enter conditions or events
relating … Do not enter an amount on the line that lists the payer …

PT01 with Medicare v7.1 – Finance and Administration Cabinet

Aug 8, 2014 … Inserted new UB-04 claim form and descriptors. 1.7 … Inserted new Rep list per
Stayce Towles. … Outpatient Revenue Code list per Alisha Clark. …… women who
have a confirmed cancerous or pre-cancerous condition of the …

Dialysis Billing Manual – State of Colorado

Hospitalization is required for a covered medical condition and … schedule.
Ancillary services performed in addition to the routine dialysis treatment …. All
code values listed in the NUBC UB-04 Reference Manual for each form locator
may not …

NH UHFDDS User Guide – New Hampshire Department of Health …

Hospital Code and Type: . …. Occurrence Code and Dates: . …. The current rule is
based on the UB-04 form, and the new system has been …. this Code List. 99.

(CMS-1450) (UB-04) – CT.gov

PPS. CODE. QUAL. LAST. LAST. National Uniform. Billing Committee. NUBC™.

CHARS Procedure Manual – Washington State Department of Health

Jul 1, 1989 … UB04 Data Elements Required for CHARS . ….. Assigns CMS, MDC, MS-DRG
and value-added fields – Washington State weights and case mix indices …. of
health care facility not defined elsewhere in this code list. 8.


Dec 1, 2016 … National Drug Code (NDC) Billing Requirements for Outpatient Hospital. Setting .
….. A list of vendors who supply the UB-04 form can also be found in Section 4 ….
Fields 18-28 – Condition Codes: Always enter. “C5” in field 18 …

LTCElectronicClaimSubmittal – Illinois.gov

May 4, 2016 … N/A. Text Box. Condition Codes. Code indicating a code from a specific industry
code list. UB-04 Reference: FL 18 through 28 Condition Codes.

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