UB04/CMS1450 Condition Codes - Group 4
- 40 The patient was transferred to another participating Medicare provider before midnight on the day of admission. UB04 Condition Code
- 41 The claim is for partial hospitalization services. For outpatient services, this includes a variety of psychiatric programs (such as drug and alcoh
- 42 Continuing care plan is not related to the condition or diagnosis for which the individual received inpatient hospital services. UB04 Condition Cod
- 43 Continuing care plan was related to the inpatient admission but the prescribed care was not provided within the post discharge window. UB04 Condit
- 44 For use on outpatient claims only, when the physician ordered inpatient services, but upon internal utilization review performed before the claim w
- 45 Reserved for national assignment UB04 Condition Code
- 46 A nonavailability statement must be issued for each TRICARE claim for nonemergency inpatient care when the TRICARE beneficiary resides within the c
- 47 Reserved for TRICARE UB04 Condition Code
- ABC Medical Services, Remedies, and Supply Codes - Group
- 49 Replacement of a product earlier than the anticipated lifecycle due to an indication that the product is not functioning properly. UB04 Condition C
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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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