UB04/CMS1450 Condition Codes - Group 2
- 20 Provider realizes services are non-covered level of care or excluded, but beneficiary requests determination by payer. (Currently limited to home h
- 21 The provider realizes services are at a noncovered level or excluded, but it is requesting a denial notice from Medicare in order to bill Medicaid
- 22 PATIENT ON MULTIPLE DRUG REGIMEN UB04 Condition Code
- 23 HOME CARE GIVER AVAILABLE UB04 Condition Code
- 24 HOME IV PATIENT ALSO RECEIVING HHA SERVICES UB04 Condition Code
- 25 PATIENT IS NON-U.S. RESIDENT UB04 Condition Code
- 26 Patient is VA eligible and chooses to receive services in a Medicare certified facility instead of a VA facility. UB04 Condition Code
- 27 (Sole Community Hospitals only). The patient was referred for a diagnostic laboratory test. The provider uses this code to indicate laboratory serv
- 28 In response to development questions, the patient and/or spouse indicated that one or both are employed and that there is group health insurance fr
- 29 In response to development questions, the patient and/or family member(s) indicated that one or more are employed and there is group health insuran
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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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