UB-04 Discharge Date 2025 Guidance: FL 6, 17, & 31-34 Explained for Accurate Claims

Understanding the discharge date on UB-04, including specific UB-04 patient status codes and UB-04 discharge status codes, is paramount for accurate inpatient hospital billing in 2025. This comprehensive guide clarifies current rules, payer expectations, and provides practical tips to minimize claim denials, emphasizing adherence to the latest 2025 UB-04 guidance.

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 31-34 (Occurrence Code 42), and FL 17 (Patient Discharge Status). Understanding these elements is essential for accurate and compliant claims submission, especially concerning **UB04 admit/discharge date range** details.

Understanding the UB-04 Discharge Date: Form Locators Explained (FL 6, FL 17, FL 31-34)

The discharge date in UB 04 form is reported across several critical fields, each serving a distinct purpose in documenting the patient’s departure from inpatient care. Correctly populating these form locators (FLs) is vital for compliant UB-04 claim submission.

FL 6: “Statement Covers Period” – Admission Date on UB04 and Through Date

Form Locator 6 specifies the UB-04 admit/discharge date range for which services are being billed. It includes both the “From” (admission date on UB04) and “Through” dates. The “Through” date represents the last day of services covered by the bill. This is a common point of confusion: while often the same as the actual discharge date, the FL 6 “Through” date indicates the end of the billing period, which might precede the physical discharge date if the patient remained in the facility for non-billable services (e.g., awaiting transfer). Always ensure the “Through” date accurately reflects the final day of billable inpatient care.

FL 17: Patient Discharge Status Code

This field, also known as field 17 on UB04, requires a two-digit UB04 patient status code (or UB-04 discharge status code) that precisely indicates the patient’s disposition upon leaving the facility. For example, what does an 03 in box 17 of a UB mean? It signifies a transfer to a skilled nursing facility (SNF). This code is crucial because it informs payers about the next level of care or the patient’s final outcome, directly impacting eligibility for subsequent services and reimbursement. The choice of code must align with the patient’s actual discharge outcome.

FL 31-34: Occurrence Code 42 (Actual Discharge Date)

When the “Through” date in FL 6 differs from the patient’s actual discharge date, Occurrence Code 42 must be used in one of Form Locators 31-34. This code, followed by the actual discharge date, clarifies the precise date the patient physically left the facility. It is mandatory on final inpatient claims (Type of Bill frequency 1 or 4) to ensure accurate reporting, especially when the end of billable services (FL 6 “Through” date) doesn’t perfectly coincide with the patient’s physical departure. This helps payers reconcile the duration of billable care with the patient’s actual release date.

Common NUBC Patient Discharge Status Codes (FL 17)

Understanding the widely used UB-04 patient status codes is fundamental for accurate billing. Here’s a list of some of the most common codes for Form Locator 17:

• 01 – Discharged to Home or Self Care (Routine Discharge): Patient is released to their residence without needing organized home healthcare or other institutional services.
• 02 – Discharged/Transferred to Another Short-Term General Hospital: Patient is transferred to another acute care facility for continued inpatient care.
• 03 – Discharged/Transferred to Skilled Nursing Facility (SNF) with Medicare Certification: Patient is transferred to a Medicare-certified SNF for post-acute care.
• 05 – Discharged/Transferred to designated cancer center or children’s hospital: Patient is transferred to a specialized facility.
• 06 – Discharged/Transferred to Home under care of organized home health service organization: Patient is discharged to their home but requires skilled nursing or therapy services provided by a home health agency.
• 20 – Expired: Patient died.
• 30 – Still Patient: Patient is an inpatient at the time the bill is submitted (used for interim bills).
• 43 – Discharged/Transferred to a Federal Hospital: Patient is transferred to a federal facility (e.g., VA hospital).
• 50 – Discharged/Transferred to Hospice – Home: Patient is discharged to home for hospice care.
• 51 – Discharged/Transferred to Hospice – Medical Facility: Patient is discharged to a medical facility (e.g., SNF, hospital) for hospice care.

This list is not exhaustive. Always refer to the official NUBC UB-04 Data Specifications Manual for the complete and most current list of UB04 status codes.

UB Condition Codes: What They Are and How They Differ from Discharge Status Codes

While the primary focus of this article is on the discharge date on UB04 and UB-04 patient status codes, it’s helpful to briefly understand UB condition codes. Condition codes are reported in Form Locators 18-28 and describe conditions or events that are relevant to the claim but are not diagnosis codes or procedure codes. They provide additional information that may affect payment processing, such as circumstances related to a patient’s admission or treatment.

It’s important to differentiate NUBC condition codes from UB-04 discharge status codes. Condition codes describe aspects of the patient’s stay or billing scenario (e.g., accident related, delayed filing), whereas discharge status codes specifically define the patient’s destination or disposition upon leaving the hospital. Both are crucial for comprehensive and compliant billing, but they serve distinct informational purposes on the UB-04 form.

2025 UB-04 Guidance: Emphasizing Adherence to NUBC and Medicare Part A Rules

The 2025 guidance for UB-04 claims strongly reaffirms the importance of strict adherence to existing National Uniform Billing Committee (NUBC) and Medicare Part A rules for accurate reporting of the discharge date on a UB04. While no radical new CMS changes have been introduced for 2025 specifically regarding discharge date mechanics, compliance remains critical due to heightened enforcement and updated payer policies.

In 2025, CMS and major payers continue to enforce stringent completion of UB-04 fields, particularly for Medicare Part A claims. As before, Occurrence Code 42 is required with the actual discharge date when the “Through” date in FL 6 differs. Simultaneously, UB04 patient status codes must be accurate and consistent with the most current NUBC definitions. For example, UnitedHealthcare’s 2025 UB-04 policy specifically reiterates the necessity of correctly linking the type-of-bill with discharge status and date fields, warning that any mismatch can trigger denials or processing delays. This renewed focus underscores that diligent and precise reporting, following established guidelines, is more important than ever to avoid claim rejections and ensure timely reimbursement.

Impact on Billing & Claims Processing: Avoiding Denials Related to Discharge Information

Incorrect or missing discharge date on UB04 information can severely impact your revenue cycle, leading to significant claim rejections and payment delays. Specific scenarios that often result in denials include:

• Claim Rejections: Inpatient UB-04s submitted without Occurrence Code 42 when the actual discharge date differs from the FL 6 “Through” date are frequently rejected.
• Payment Delays: When the UB04 patient status code (FL 17) does not accurately reflect the patient’s disposition or mismatches the type of bill or frequency code, claims often face delays or requests for further documentation.
• Denials for Subsequent Care: Incorrect or unclear inpatient discharge dates can lead to denials for follow-on care, such as Skilled Nursing Facility (SNF) admissions or home health services. For instance, if a patient is discharged to home with home health, but the UB-04 incorrectly lists a routine discharge (01) instead of discharge to home under care of organized home health service organization (06), the home health agency’s claim may be denied due to conflicting information regarding the preceding acute stay. Similarly, if the inpatient discharge date for a transfer to another acute care facility is misreported, the receiving facility might face difficulties in billing.

How to Adapt to 2025 UB-04 Discharge Date Rules

1. Complete All Relevant Form Locators Accurately

• FL 6 (Statement Covers Period): Use accurate admission date on UB04 and “Through” dates that reflect the statement period.
• FL 31–34 (Occurrence Code 42): Enter code “42” and the actual discharge date in UB 04 form if it differs from the FL 6 “Through” date.
• FL 17 (Patient Discharge Status): Choose the correct UB-04 discharge status code from the NUBC list (e.g., 01 for routine discharge, 03 for transfer to SNF, 20 for expired).

2. Match Frequency Codes with Patient Discharge Status Codes

• Frequency 1 or 4 indicates a final claim; therefore, FL 17 must reflect an appropriate UB04 status code (e.g., routine discharge, SNF transfer).
• Frequency 2 or 3 (interim claim) typically omits Occurrence Code 42 until the final claim is submitted.

3. SNF-Related Billing Considerations for Discharge Status

If discharging a patient to a Skilled Nursing Facility (SNF), the hospital must clearly document inpatient days and the precise discharge date on UB04 to meet the Medicare 3-day rule. SNF providers rely on Occurrence Span Code 70 and accurate discharge dates for billing eligibility of post-acute care.

Example UB-04 Claim Entries: Varied Discharge Scenarios

Here are practical examples demonstrating correct UB-04 discharge date and patient status code reporting for different discharge scenarios:

Scenario 1: Discharge to Skilled Nursing Facility (SNF)

• FL 6 (Statement Covers Period): 051025–051130 (Patient admitted May 10, discharged November 30, bill covers this full period)
• FL 31a (Occurrence Code 42): Code 42, Date: 113025 (Actual discharge date, matching FL 6 “Through” date in this case)
• FL 17 (Patient Discharge Status): Status 03 (Discharged/transferred to SNF)

Scenario 2: Discharge to Home with Home Health Services

• FL 6 (Statement Covers Period): 030125–030525 (Patient admitted March 1, discharged March 5)
• FL 31a (Occurrence Code 42): Code 42, Date: 030525
• FL 17 (Patient Discharge Status): Status 06 (Discharged/transferred to Home under care of organized home health service organization)

Scenario 3: Discharge to Another Acute Care Facility

• FL 6 (Statement Covers Period): 071525–072025 (Patient admitted July 15, transferred July 20)
• FL 31a (Occurrence Code 42): Code 42, Date: 072025
• FL 17 (Patient Discharge Status): Status 02 (Discharged/transferred to another short-term general hospital)

Scenario 4: Discharge with Hospice Care

• FL 6 (Statement Covers Period): 090125–091025 (Patient admitted September 1, discharged September 10)
• FL 31a (Occurrence Code 42): Code 42, Date: 091025
• FL 17 (Patient Discharge Status): Status 50 (Discharged/transferred to Hospice – home) or 51 (Discharged/transferred to Hospice – Medical facility)

Frequently Asked Questions (FAQs) on UB-04 Discharge Data

Where do I find the discharge date and status on a UB-04 form?

The patient’s actual discharge date is typically found in Form Locators 31-34, specifically when Occurrence Code 42 is used. The discharge hour in UB04 is not explicitly reported in a dedicated field but is part of internal facility records. The patient’s discharge status is reported in FL 17, using a two-digit UB04 patient status code.

Which field on the UB-04 form is used to report the patient’s discharge status?

The patient’s discharge status is reported in Form Locator (FL) 17, titled “Patient Status.” This field uses specific UB04 status codes defined by the NUBC to indicate the patient’s disposition upon leaving the facility.

What does an 03 in box 17 of a UB mean?

An “03” in FL 17 (Patient Status) on a UB-04 means the patient was “Discharged/transferred to a Skilled Nursing Facility (SNF) with Medicare certification.” This indicates a specific post-acute care plan covered by Medicare.

What if the discharge date and the “Through” date in FL 6 match?

If the actual discharge date matches the “Through” date in FL 6, Occurrence Code 42 in FL 31-34 is generally only needed if a specific payer explicitly requires it. Many systems accept the same date in both fields without code 42, but it is always best to verify individual payer policies.

Can interim claims include Occurrence Code 42?

No, Occurrence Code 42 should not be used on interim claims (Type of Bill frequency 2 or 3). It is reserved for final claims (Type of Bill frequency 1 or 4) to report the actual discharge date.

Which UB-04 discharge status code should I use?

You must select the appropriate UB-04 discharge status code from the NUBC-approved list for 2025 based on the patient’s actual disposition. Common codes include: 01 (Routine Discharge), 03 (Transferred to SNF), 06 (Discharged to Home under care of organized home health), 20 (Expired), and 30 (Still Patient). Refer to the full NUBC specifications for all valid codes.

What about the admission date on UB04?

The admission date on UB04 is reported in Form Locator 6, as the “From” date in the “Statement Covers Period” field. This date signifies the beginning of the inpatient stay being billed.

Is the discharge hour in UB04 reported?

While the exact discharge hour in UB04 is critical for internal hospital operations and sometimes for calculating observation hours, there isn’t a specific Form Locator on the UB-04 for reporting the time of discharge. The date is the primary focus for external billing purposes.

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: Ensuring UB-04 Discharge Date Accuracy for 2025 Compliance

Accurate reporting of the discharge date on UB-04, along with the correct UB-04 discharge status codes in FL 17, remains vital for clean claims and streamlined reimbursement in 2025. By diligently completing Form Locators 6, 17, and 31-34, understanding the distinction between “Through” dates and actual discharge dates, and matching frequency codes to the appropriate patient status codes, healthcare providers can significantly minimize denials and accelerate reimbursement cycles. Staying current with 2025 UB-04 guidance from CMS and payer-specific policies, coupled with consistent staff training and robust internal audit processes, is crucial for maintaining compliance and financial health. For continuous updates and further insights into complex medical billing topics, regularly visit our website.