UB04/CMS1450 Condition Codes - Group 7
- 70 Code indicates the billing is for a home dialysis patient who self administers an anemia management drug such as erythropoetin alpha (EPO) or darbe
- 71 The billing is for a patient who received staff-assisted dialysis services in a hospital or renal dialysis facility. UB04 Condition Code
- 72 The billing is for a patient who managed their own dialysis services without staff assistance in a hospital or renal dialysis facility. UB04 Condit
- 73 The bill is for special dialysis services where a patient and their helper (if necessary) were learning to perform dialysis. UB04 Condition Code
- 74 The bill is for a patient who received dialysis services at home. UB04 Condition Code
- 75 Not used for Medicare. UB04 Condition Code
- 76 The bill is for a home dialysis patient who received back-up dialysis in a facility. UB04 Condition Code
- 77 The provider has accepted or is obligated/required to accept payment as payment in full due to a contractual arrangement or law. Therefore, no Medi
- 78 The bill is for a newly covered service under Medicare for which a managed care plan does not pay. (For outpatient bills, condition code 04 should
- 79 Physical therapy, occupational therapy, or speech pathology services were provided offsite. 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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