UB04/CMS1450 Condition Codes - Group C
- C1 Claim has been reviewed by the QIO and has been fully approved including any outlier. UB04 Condition Code
- C2 AUTOMATIC APPROVAL AS BILLED BASED ON FOCUSED REVIEW UB04 Condition Code
- ABC Medical Services, Remedies, and Supply Codes - Group
- C4 The patient's need for inpatient services was reviewed and the QIO found that none of the stay was medically necessary. UB04 Condition Code
- C5 Any medical review will be completed after the claim is paid. UB04 Condition Code
- C6 The QIO authorized this admission/procedure but has not reviewed the services provided. UB04 Condition Code
- C7 The QIO has authorized these services for an extended length of time but has not reviewed the services provided. UB04 Condition Code
- C8 Reserved for national assignment UB04 Condition Code
- C9 Reserved for national assignment UB04 Condition Code
- CA Reserved for national assignment UB04 Condition Code
- CB Reserved for national assignment UB04 Condition Code
- CC Reserved for national assignment UB04 Condition Code
- CD Reserved for national assignment UB04 Condition Code
- CE Reserved for national assignment UB04 Condition Code
- CF Reserved for national assignment UB04 Condition Code
- CG Reserved for national assignment UB04 Condition Code
- CH Reserved for national assignment UB04 Condition Code
- CI Reserved for national assignment UB04 Condition Code
- CJ Reserved for national assignment UB04 Condition Code
- CK Reserved for national assignment UB04 Condition Code
- CL Reserved for national assignment UB04 Condition Code
- CM Reserved for national assignment UB04 Condition Code
- CN Reserved for national assignment UB04 Condition Code
- CO Reserved for national assignment UB04 Condition Code
- CP Reserved for national assignment UB04 Condition Code
- CQ Reserved for national assignment UB04 Condition Code
- CR Reserved for national assignment UB04 Condition Code
- CS Reserved for national assignment UB04 Condition Code
- CT Reserved for national assignment UB04 Condition Code
- CU Reserved for national assignment UB04 Condition Code
- CV Reserved for national assignment UB04 Condition Code
- CW Reserved for national assignment UB04 Condition Code
- CX Reserved for national assignment UB04 Condition Code
- CY Reserved for national assignment UB04 Condition Code
- CZ Reserved for national assignment 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
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