Value code 80 is a crucial element in institutional medical billing, particularly for hospitals and skilled nursing facilities. It represents the number of covered days within a claim’s billing period. In 2025, accurately reporting value code 80 on the UB-04 (CMS-1450) claim form is vital for compliance and timely reimbursement. This guide breaks down the essentials of value code 80, highlights 2025 billing updates, and offers actionable tips to help you avoid costly claim denials.
What Is Value Code 80?
Value code 80 on the UB-04 claim form identifies the total number of inpatient days covered by a payer within the billing period. It’s used by institutional providers—such as hospitals, rehabilitation centers, and skilled nursing facilities—to communicate how many days were paid under the patient’s insurance plan.
This code is relevant only for institutional (not professional) claims and is typically paired with inpatient room and board charges. Value codes 81, 82, and 83 relate to non-covered days, coinsurance days, and lifetime reserve days, respectively, but value code 80 often summarizes these if required by the payer.
Why Value Code 80 Matters in 2025
In 2025, accurate reporting of value code 80 remains critical due to stricter payer validation and revised coverage limits. For instance, Medicare’s coinsurance and lifetime reserve thresholds have changed, impacting reimbursement. If the number of covered days is incorrect or missing, payers like Medicare or Medicaid may deny or delay payment.
Commercial insurers and Medicaid programs also follow updated 2025 guidelines. Failure to properly report value code 80 can lead to administrative rejections or underpayment, directly affecting your revenue cycle.
How to Report Value Code 80 on a UB-04
- Calculate covered days: Count all insurance-covered inpatient days, excluding leave of absence or private-pay days.
- Use Form Locators 39–41: Enter “80” in the value code field, typically starting with Locator 39a.
- Enter the number of days: Right-justify the number (e.g., “05” for five days). Do not include decimal points or dollar signs.
- Add value code 81 if needed: For non-covered days, use code 81 and ensure the total matches the inpatient stay length.
- Match to accommodation charges: Ensure the number of days aligns with the number of room-and-board units billed.
Common Errors to Avoid
- Omitting value code 80: Missing this code is a common cause of denials.
- Mismatched day counts: Always confirm the number of days reported matches billed services.
- Incorrect formatting: Use whole numbers without currency symbols or decimals.
- Improper day counting: Remember, the discharge date is generally not counted unless the patient is still inpatient (status code 30).
Tips for Accurate Reporting
- Stay current: Review updated guidance from CMS and your MAC.
- Use internal edits: Flag claims where room-and-board units don’t match value code 80 entries.
- Coordinate with secondary payers: Ensure total covered days make sense across both claims.
- Audit denied claims: Identify and correct recurring documentation issues tied to covered days.
Conclusion
In 2025, value code 80 remains essential to correctly reporting covered inpatient days on UB-04 claims. Following updated guidelines, matching charges to days, and avoiding common errors ensures your claims are clean, compliant, and reimbursed without delay.
For more insights, check out our guides on ICD-10 coding tips, 2025 NUBC discharge codes, and how to bill value and revenue codes.
FAQs
What is value code 80 used for?
It represents the number of insurance-covered inpatient days on a UB-04 claim form, essential for payer reimbursement.
Is value code 80 required for outpatient claims?
No. It’s only required for institutional inpatient claims involving daily accommodation charges.
How do I calculate covered days?
Count the days from admission to discharge, excluding the discharge day unless the patient is still inpatient (status 30).