Discharge Date on UB 04: Updated 2025 Guidance

The discharge date on UB 04 plays a critical role in accurately billing inpatient hospital services, especially for Medicare and Medicaid claims in 2025. This article explains current rules, payer expectations, and practical tips to reduce claim denials.

Introduction

The term discharge date on UB 04 refers to the date reported when a patient leaves inpatient care. As of 2025, Medicare, Medicaid, and many commercial payers have reinforced requirements around Form Locator 6, FL‑42 occurrence codes, and FL‑17 patient discharge status. Understanding these elements is essential for accurate and compliant claims submission.

What Is the Discharge Date on UB‑04?

• FL 6 (“Statement Covers Period – Through”) must reflect the patient’s actual last inpatient day. If that date differs from discharge, you must report it separately.
• FL 31–34 Occurrence Code 42 with the discharge date is mandatory on final inpatient claims (type‑of‑bill frequency 1 or 4) :contentReference[oaicite:0]{index=0}.
• FL 17 Patient Discharge Status Code must align with the discharge outcome (e.g., routine discharge, transfer to SNF) :contentReference[oaicite:1]{index=1}.

2025 Payer Rules & Updates

In 2025, CMS and major payers continue to enforce strict completion of UB‑04 fields, particularly for Medicare Part A claims. Occurrence code 42 is required with discharge dates when “Through” dates differ :contentReference[oaicite:2]{index=2}. Simultaneously, patient discharge status codes per NUBC definitions must be accurate and consistent :contentReference[oaicite:3]{index=3}.

Specifically, UnitedHealthcare’s 2025 UB‑04 policy reiterates correct linking of type‑of‑bill with discharge status and date fields :contentReference[oaicite:4]{index=4}. Any mismatch may trigger denials or delays.

Impact on Billing & Claims Processing

Incorrect or missing discharge data can lead to:

• Claim rejections for inpatient UB‑04s without occurrence code 42
• Payment delays when discharge status doesn’t match type of bill or frequency code
• Denials for SNF follow‑on care if inpatient discharge dates are unclear or incorrect

How to Adapt to 2025 Rules

1. Complete All Relevant Form Locators

• FL 6: Use actual admission and discharge dates for statement covers period
• FL 31–34: Enter code “42” and discharge date if different from FL 6 “through” date :contentReference[oaicite:5]{index=5}
• FL 17: Choose the correct patient discharge status code per NUBC list (e.g. 01, 03, 20) :contentReference[oaicite:6]{index=6}

2. Match Frequency Codes with Discharge Status

• Frequency 1 or 4 indicates final claim; FL 17 must reflect an appropriate discharge code (e.g. routine discharge, SNF transfer)
• Frequency 2 or 3 (interim claim) typically omits occurrence code 42 until final claim

3. SNF Related Billing Considerations

If discharging to SNF, the hospital must clearly document inpatient days and discharge date to meet the Medicare 3‑day rule. SNF providers rely on occurrence span code 70 and accurate discharge dates for billing eligibility :contentReference[oaicite:7]{index=7}.

Example Entry: Final UB‑04 Claim

• FL 6: 051025–051130 (from May 10 to November 30)
• FL 31a: Code 42, Date: 113024 (if actual discharge was Nov 30)
• FL 17: Status 03 (transferred to SNF with Medicare) or appropriate code per scenario

FAQ

What if the discharge date and the through date match?

Then occurrence code 42 is only needed if a payer explicitly requires it. Many systems accept the same date in FL 6 and FL 31–34, but verify payer policy.

Can interim claims include occurrence code 42?

No. Interim claims (frequency 2 or 3) should wait for the final claim before using code 42. Use it only on frequency 1 or 4 final claims.

Which discharge status code should I use?

Select from NUBC-approved codes as of 2025. For example, 01 is routine discharge, 03 is transfer to SNF, while 20 denotes expired status :contentReference[oaicite:8]{index=8}.

Internal & External Resources

Refer to internal articles for deeper insight:

• UB‑04 Medicare discharge status code
• common denial reasons
• ICD‑10 coding tips

Additionally, consult authoritative resources:

• CMS Medicare Claims Processing Manual
• National Uniform Billing Committee (NUBC) UB‑04 Data Specifications

Conclusion

Accurate reporting of the discharge date on UB 04 remains vital for clean claims in 2025. By properly completing Form Locators 6, 31–34, and 17, and matching frequency codes to discharge status, you minimize denials and accelerate reimbursement. Stay current with CMS and payer guidance, train staff consistently, and review internal audit reports. For more updates, visit our site regularly.