UB04/CMS1450 Claim Form, Codes & Information
Diagnosis (Dx)ICD-10-CM Codes DRG - Diagnosis Related Groups ICD-9-CM - Volume 1
Procedure (Tx)CPT® - Level I Codes & Modifiers HCPCS - Level II Codes & Modifiers ICD-10-PCS - Codes APC - Ambulatory Payment Classifications ICD-9 Vol 3 - (Inpatient Only)
Claim Form CodesType of Bill Facility Codes - FL 4 Type of Bill Frequency Codes - FL 4 Admission/Discharge Hour - FL 13/16 Point of Origin Admission/Visit - FL 15 Patient Discharge Status - FL 17 Condition Codes - FLs 18-28 Occurrence Codes - FLs 31-34 Occurrence Span Codes - FLs 35-36 Value Codes and Amounts - FLs 39-41 Revenue Codes - FL 42 Code Codes - FL 81 Other UB04 Claim Form Codes
Helps & GuidesUB04/CMS1450 Manual - PUB100 Medicare Billing: 837I//CMS-1450/UB-04
NewslettersCPT Assistant +Archives Medicare Provider Compliance AHA Coding Clinic® ICD-10-CM/PCS AHA Coding Clinic® HCPCS
Medicare Manuals & GuidesPUB100 - Medicare Guides and Manuals Medicare Contractors - LCDs & Articles NCDs - National Coverage Determinations More... (Forms, FAQs, NCCI, etc.)
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UB04/CMS1450 Claim FormThe Office of Management and Budget and the National Uniform Billing Committee have approved the UB-04 claim form, also known as the CMS-1450 form. The Form UB-04 (CMS-1450) answers the needs of many health insurers. It is the basic form prescribed by CMS for the Medicare program and is only accepted from institutional providers that are excluded from the mandatory electronic claims submission requirements set forth in the Administrative Simplification Compliance Act, Pub.L. 107-105 (ASCA) and the implementing regulation at 42 CFR 424.32. Hospitals, nursing homes, hospice, home health agencies, and other institutional providers use the UB04 form.
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