UB04/CMS1450 Condition Codes - Group 0
- ABC Medical Services, Remedies, and Supply Codes - Group
- 02 Patient alleges that the medical condition causing this episode of care is due to environment/events resulting from the patient's employment. UB04
- 03 Indicates that patient/patient representative has stated that coverage may exist beyond that reflected on this bill. UB04 Condition Code
- 04 Indicates bill is submitted for informational purposes only. Examples would include a bill submitted as a utilization report, or a bill for a benef
- 05 The provider has filed legal claim for recovery of funds potentially due to a patient as a result of legal action initiated by or on behalf of a pa
- 06 Medicare may be a secondary insurer if the patient is also covered by employer group health insurance during the patient's first 30 months of end s
- 07 The patient has elected hospice care, but the provider is not treating the patient for the terminal condition and is, therefore, requesting regular
- 08 The beneficiary would not provide information concerning other insurance coverage. The FI develops to determine proper payment. UB04 Condition Code
- 09 In response to development questions, the patient and spouse have denied employment. UB04 Condition Code
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What are UB04 Condition Codes?
Form CMS-1450 (UB-04)This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers. Because it serves many payers, a particular payer may not need some data elements. The National Uniform Billing Committee (NUBC) maintains lists of approved coding for the form. All items on Form CMS-1450 are described. The FI must be able to capture all NUBC-approved input data described in section 75 (of the Medicare Claims Processing Manual Chapter 25) for audit trail purposes and be able to pass all data to other payers with whom it has a coordination of benefits agreement.
CMS1450/UB04 Fields: 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28 are places for Condition Codes. The provider enters the corresponding code (in numerical order) to describe any conditions or events that apply to the billing period.
Source: Adapted from the Medicare Claims Processing Manual Chapter 25 - Completing and Processing the Form CMS-1450 Data Set
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