As a U.S.-based medical biller or coder, you’ve likely come across UB92 in your workflow. Originally introduced decades ago, it’s still relevant in certain payer systems and can impact your revenue cycle in 2025. In this article, we’ll dive into the latest updates, payer rules, and expert tips to keep your billing compliant and efficient.
📌 What Is UB92? A Quick Overview
UB92—formally the CMS-1450—is a standard claim form used by institutional providers (e.g., hospitals, skilled nursing facilities). Although largely supplanted by UB04 (CMS-1450 revision 04), some payers and legacy systems continue to accept UB92 for specific billing scenarios.
2025 Updates Affecting UB92 Billing
In 2025, new payer rules and coding guidelines influence UB92 usage. Here are the top updates:
- Payer Legacy System Extensions: Certain Medicaid and state plan payers now accept UB92 through June 2025 to transition fully to UB04.
- Value-Based Reporting Codes: New revenue codes tied to post-acute and telehealth services must be included even on UB92 to receive reimbursement.
- Electronic Remittance Standards: With HIPAA 5010 mandates firmly in place, UB92 claims must still meet ANSI 835 electronic EDI remittance formats by Sept 2025.
- Documentation Requirements: Enhanced medical necessity documentation is required when revenue codes indicate bundled or global payment arrangements.
Why UB92 Still Matters in 2025
Although UB04 is standard, UB92 persists due to several factors:
- Legacy Payer Compatibility: Some state Medicaid systems and Blue Cross affiliates lack full UB04 integration.
- Billing Software Constraints: Practices using older software versions may only support UB92 templates.
- Specific Reimbursement Workflows: In unique cases—like inpatient rehab or transitional care services—UB92 forms remain accepted.
How to Adapt Your Billing Workflow
1. Stay Updated on Payer Announcements
Regularly check sources like CMS 2025 official guidelines and state Medicaid bulletins. For example, some states have extended UB92 acceptance through 2026.
2. Configure Your Billing System Correctly
- Enable dual-form generation (UB92 and UB04) when submitting to hybrid payers.
- Review revenue code mappings, especially for telehealth and post-acute services.
- Ensure ANSI 835 compliance to align with HIPAA 5010 standards.
3. Strengthen Documentation & Coding Practices
Additionally, append clear medical necessity statements when codes may affect bundled payments. For instance, include a note like “skilled nursing services post-TKA” alongside relevant CPT/HCPCS codes.
4. Monitor Denials & Write-offs
Track UB92-specific denials (e.g., “invalid form type”) using your revenue cycle dashboard. Common denial reasons often relate to outdated revenue codes or missing supplemental attachments. Review your common denial reasons guide for patterns.
Example: Telehealth on a UB92 Claim
For post-acute telehealth services accepted on UB92 in 2025:
- Include appropriate revenue code (e.g., 0782 – Telehealth).
- Ensure CPT code (e.g., 99441) is mapped correctly.
- Attach documentation specifying date, duration, and provider credentials.
Internal & External Quality Resources
- Internal: ICD-10 coding tips — to audit diagnosis consistency with revenue codes.
- Internal: prior authorization guidelines — to prepare for any UB92 service requiring prior auth.
- External: AAPC resources — for updated institutional coding education and webinars.
- External: CMS 2025 official guidelines — including HIPAA 5010 and ANSI 835 updates.
FAQ: Common Questions About UB92 in 2025
Is UB92 still accepted by all payers?
No. Most payers require UB04 now. However, some legacy Medicaid or state systems still accept UB92 through mid‑2025 or until they complete system upgrades.
Can I file UB92 electronically?
Yes. HIPAA 5010 standards allow electronic submission of UB92 if the payer supports it—otherwise you may need to print and mail the claim.
What if a payer denies UB92 submissions?
Check denial codes and update your form type mapping. Contact payer support and refer to your internal guidelines and the common denial reasons article to troubleshoot repeat issues.
Conclusion
In summary, UB92 may seem outdated, but it remains relevant in 2025—especially when dealing with legacy payer systems and specific institutional workflows. Keep abreast of payer bulletins, configure your billing system to handle hybrid formats, and ensure documentation meets updated standards. By doing so, you’ll prevent unnecessary denials, improve cash flow, and maintain compliance.
Therefore, integrate these best practices into your revenue cycle operations now—and stay tuned for future updates as more payers fully transition to UB04. Visit CMS1500ClaimBilling.com for ongoing resources and deep‑dive guides.