Mastering UB-04 Field 4: Your Guide to 3-Digit Type of Bill Codes
UB-04 Field 4, also known as the Type of Bill code, is a critical component of institutional claims (formerly CMS 1450). This mandatory three-digit code communicates essential information about the facility type, patient classification, and the billing frequency to payers. Understanding and accurately completing these UB-04 Field 4 codes is paramount for ensuring timely reimbursement and avoiding claim rejections. This comprehensive guide will walk you through each of the three digits, providing a clear breakdown of the Type of Bill components and practical tips on how to fill UB-04 Field 4 correctly.
Decoding the UB-04 Type of Bill: The 3-Digit Structure
The three digits of the UB-04 Type of Bill code each convey specific information:
- First Digit: Identifies the type of facility submitting the claim.
- Second Digit: Classifies the patient based on the type of care (e.g., inpatient, outpatient) and the facility type.
- Third Digit: Indicates the frequency of the bill in a series of claims for a specific period of care or a special claim type.
First Digit: Type of Facility
The first digit of your UB-04 Type of Bill code identifies the type of facility submitting the claim.
| Digit | Facility Type |
|---|---|
| 1 | Hospital |
| 2 | Skilled Nursing (Used by Hospital-based multi-unit complexes for non-hospital services) |
| 3 | Home Health (Used by Hospital-based multi-unit complexes for non-hospital services) |
| 4 | Religious Non-Medical (Hospital) |
| 7 | Clinic or Renal Dialysis Facility (requires special information in second digit) |
| 8 | Special Facility or Hospital ASC Surgery (requires special information in second digit) |
Second Digit: Patient Classification (For Facility Digits 1-5)
The second digit further classifies the type of care provided, specific to facility types 1 through 5.
| Digit | Classification |
|---|---|
| 1 | Inpatient (Part A) |
| 2 | Hospital-Based or Inpatient (Part B) (includes HHA visits under a Part B plan of treatment) |
| 3 | Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment) |
| 4 | Other (Part B) (includes HHA medical and other health services not under a plan of treatment, hospital and SNF for diagnostic clinical laboratory services for “nonpatients”) |
| 8 | Swing bed (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement) |
Second Digit: Patient Classification (For Facility Digit 7 – Clinic/Renal Dialysis)
For Clinic or Renal Dialysis Facilities (first digit ‘7’), the second digit indicates a specific service type.
| Digit | Classification |
|---|---|
| 1 | Rural Health Clinic (RHC) |
| 2 | Hospital-Based or Independent Renal Dialysis Facility |
| 4 | Other Rehabilitation Facility (ORF) |
| 5 | Comprehensive Outpatient Rehabilitation Facility (CORF) |
| 6 | Community Mental Health Center (CMHC) |
| 7 | Free-Standing Provider-Based Federally Qualified Health Center (FQHC) |
Second Digit: Patient Classification (For Facility Digit 8 – Special/Hospital ASC)
When the first digit is ‘8’ for Special Facility or Hospital ASC Surgery, the second digit details the specific service.
| Digit | Classification |
|---|---|
| 1 | Hospice (Nonhospital-based) |
| 2 | Hospice (Hospital-based) |
| 5 | Critical Access Hospital (CAH) |
Third Digit: Frequency of Bill
The third digit specifies the sequence of this bill in a series of bills for a specific period of care, or indicates special claim types.
| Code | Description |
|---|---|
| A | Admission/Election Notice |
| B | Hospice/Medicare Coordinated Care Demonstration/Religious Non-Medical Health Care Institution-Termination/Revocation Notice |
| C | Hospice Change of Provider |
| D | Hospice/Medicare Coordinated Care Demonstration/Religious Non-Medical Health Care Institution-Void/Cancel |
| E | Hospice Change of Ownership |
| F | Beneficiary Initiated Adjustment Claim (For A/B MAC (A) use only) |
| G | CWF Initiated Adjustment Claim (For A/B MAC (A) use only) |
| H | CMS initiated Adjustment Claim (For A/B MAC (A) use only) |
| I | A/B MAC (A) Adjustment Claim (Other than QIO or Provider) (For A/B MAC (A) use only) |
| J | Initiated Adjustment Claim-Other (For A/B MAC (A) use only) |
| K | OIG Initiated Adjustment Claim (For A/B MAC (A) use only) |
| M | MSP Initiated Adjustment Claim (For A/B MAC (A) use only) |
| P | QIO Adjustment Claim (For A/B MAC (A) use only) |
| Q | Claim Submitted for Reconsideration Outside of Timely Limits (For A/B MAC (A) use only) |
| 0 | Nonpayment/zero claims |
| 1 | Admit Through Discharge Claim |
| 2 | Interim – First Claim |
| 3 | Interim – Continuing Claims (Not valid for PPS bills. Exception: SNF PPS bills) |
| 4 | Interim – Last Claim (Not valid for PPS bills. Exception: SNF PPS bills) |
| 5 | Late charge |
| 7 | Correction |
| 8 | Void/Cancel |
| 9 | Final Claim for a Home Health PPS Episode |
Practical Examples: Forming Common UB-04 Type of Bill Combinations
Understanding how the three digits combine is crucial for accurate institutional billing codes. Here are a few common UB-04 Field 4 codes:
- 111: Hospital Inpatient Admit Through Discharge – This code signifies a hospital (1) providing inpatient care (1), with the claim covering the entire admission to discharge period (1).
- 131: Hospital Outpatient Admit Through Discharge – This represents a hospital (1) providing outpatient services (3), with the claim covering a single visit or the entire outpatient stay (1).
- 137: Hospital Outpatient Correction – Used when a hospital (1) providing outpatient services (3) needs to submit a correction to a previously filed claim (7).
- 321: Home Health Inpatient (Part B) Admit Through Discharge – This code identifies a home health agency (3), billing for services under a Part B plan (2), for an admit through discharge period (1).
- 851: Critical Access Hospital (CAH) Admit Through Discharge – For a Critical Access Hospital (8), providing CAH services (5), for an admit through discharge period (1).
Common UB-04 Field 4 Errors and How to Avoid Them
Errors in UB-04 Field 4 codes are a common reason for claim rejections or denials. Preventing these issues is vital for efficient revenue cycles. Here are some frequent mistakes:
- Incorrect Facility Type: Using ‘1’ for a Skilled Nursing Facility that should use ‘2’ can lead to immediate rejection. Always ensure the first digit accurately reflects your facility type.
- Mismatched Classification: Selecting an inpatient classification (‘1’ or ‘2’) for an outpatient service (‘3’) is a frequent error. Double-check the patient’s status and the nature of the service.
- Inaccurate Frequency Code: Submitting an “Interim – First Claim” (‘2’) when it should be a “Correction” (‘7’) will cause problems. Understand the lifecycle of a claim and choose the appropriate frequency.
- Outdated Codes: Relying on old code lists. These codes are subject to updates, so always refer to the latest official guidance.
To avoid these errors and accurately understand how to fill UB-04 Field 4, implement robust training, use up-to-date coding manuals, and perform internal audits.
Frequently Asked Questions (FAQ) about UB-04 Field 4
- What is the UB-04 Field 4 Type of Bill code?
- The UB-04 Field 4 Type of Bill code is a mandatory three-digit code on institutional claims that identifies the type of facility, the patient’s classification (e.g., inpatient, outpatient), and the frequency of the bill (e.g., admit through discharge, interim, correction).
- Why is accurately completing UB-04 Field 4 important?
- Accurate completion of UB-04 Field 4 is critical because it tells payers key information about the claim. Incorrect codes can lead to claim rejections, denials, payment delays, and compliance issues.
- Can the Type of Bill code change for the same patient?
- Yes, especially the frequency digit. For an extended inpatient stay, you might submit an ‘Interim – First Claim’ (e.g., 112), followed by ‘Interim – Continuing Claims’ (e.g., 113), and finally an ‘Interim – Last Claim’ (e.g., 114) or an ‘Admit Through Discharge’ (e.g., 111) if the stay is short.
- Where can I find the most current UB-04 Type of Bill codes?
- Always refer to the most current official CMS manuals, specifically the Medicare Claims Processing Manual, or consult your specific Medicare Administrative Contractor (MAC) for the latest and most accurate coding guidelines. These codes are subject to periodic updates.
Important Disclaimer
The information provided in this guide is for general informational purposes only and is not intended as legal, medical, or coding advice. While we strive to keep the information accurate and up-to-date, UB-04 Field 4 codes and billing regulations are complex and subject to change. Users must always refer to the most current official CMS manuals or consult their specific Medicare Administrative Contractor (MAC) or professional coding resources for the latest and most accurate coding guidelines applicable to their situation. Failure to use current and correct codes can result in claim rejections or denials.