UB04/CMS1450 Condition Codes - Group 1
- 10 In response to development questions, the patient and/or spouse indicated that one or both are employed but have no group health insurance under an
- 11 In response to development questions, the disabled beneficiary and/or family member indicated that one or more are employed, but have no group cove
- 12 Payer Codes UB04 Condition Code
- 13 Payer Codes UB04 Condition Code
- 14 Payer Codes UB04 Condition Code
- 15 The claim is a clean claim in which payment was delayed due to a CMS processing delay. Interest is applicable, but the claim is not subject to CPE/
- 16 An exemption from the post-hospital requirement applies for this SNF stay or the qualifying stay dates are more than 30 days prior to the admission
- 17 The patient is homeless. UB04 Condition Code
- 18 A dependent spouse entitled to benefits who does not use her husband's last name. UB04 Condition Code
- 19 A patient who is a dependent child entitled to benefits that does not have his/her father's last name. UB04 Condition Code
Back to UB04/CMS1450 Condition Codes Groups List
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
Thank you for choosing Find-A-Code, please Sign In to remove ads.