List of UB-04 Condition Codes
UB-04 only value codes: 80 – Covered days (the number of days covered by the
primary payer as qualified by the payer). 81 – Non-Covered Days (days of care …
(NUBC) maintains lists of approved coding for the form. Medicare Administrative
…. FL35 Occurrence Span Code/From/Through a AN/N/N 2/6/6. 1/1/1.
SUBJECT: Point of Origin Codes Update to the UB-04 (CMS-1450) Manual Code
List … (previously named Source of Admission) codes E and F. X COBC ….. 3
Elective – The patient's condition permitted adequate time to schedule the.
The requirements for filing an electronic version of the UB-04 claim form for
inpatient services are slightly …. 18*-24*Condition Codes (continued) A1-Healthy
Children & Youth/EPSDT … List appropriate accommodation revenue codes first
Sep 16, 2016 … UB-04 CLAIM FORM INSTRUCTIONS. FIELD. NUMBER … 4. Type of Bill. Enter
the four digit code that identifies the specific type …. Occurrence Codes and.
Dates … List applicable NDC if field 44 is a J code which requires an …
PA PROMISe™. Provider Handbook. 837 Institutional/UB-04 Claim Form. UB-04
Desk Reference for Hospitals … Condition Codes. (Form Locators 18–28).
Jan 30, 2017 … Form Locator Code – Lists one of four codes that denote how the Form Locator
should be …. Condition Codes, please refer to the UB-04 Desk.
This list has been provided to assist you with resolving these denied claims prior
…. UB 04 – Value code 80, enter the number of covered days for inpatient.
UB04) and CMS manual 100-4 Ch 9 (RHC claims) … FL 35 – 36 = Occurrence
span codes – not used in. RHC … codes are appropriate as primary codes; list.
Jun 3, 2016 … NOTE: This chapter applies to paper CMS 1500, UB-04, and ADA ….. dialysis
training must enter “73” in any Condition Code field and bill … The NDC Unit of
Measurement Qualifier (see 1500 form field 24 page 5-6 for list).
Sep 1, 2016 … UB-04 Claim Form Instructions …. Condition Codes: Enter conditions or events
relating … Do not enter an amount on the line that lists the payer …
Dec 1, 2016 … National Drug Code (NDC) Billing Requirements for Outpatient Hospital. Setting .
….. Appendix 3 of this manual for the Copayment Schedule. Also, pursuant to this
… Medicaid claims must be filed on the UB-04 claim form. Alternative …..
admissions. SCDHHS has implemented the use of Condition Code B4.
May 18, 2016 … A list of all available Revenue Codes can be found in the NUBC UB-04 Official
Data Specifications. Manual. … non-covered occurrence span code 74 with the
appropriate LOA dates even though some bed reserve days may …
Aug 8, 2014 … Inserted new UB-04 claim form and descriptors. 1.7 … Inserted new Rep list per
Stayce Towles. … Outpatient Revenue Code list per Alisha Clark. …… women who
have a confirmed cancerous or pre-cancerous condition of the …
Hospital Code and Type: . …. Value Codes and Amounts: . …. The current rule is
based on the UB-04 form, and the new system has been …. this Code List. 99.
Refer to the Colorado Medical Assistance Program UB-04 Revenue Code Table
… complete listing of services and the corresponding valid revenue codes. …
management of, the prior stay's medical condition, the hospital must bill these …
Oct 30, 2015 … Will ICD-10-PCS procedure codes be used for both inpatient and outpatient
hospital services? …. Please see the list of unspecified diagnosis codes on the
GAMMIS web portal, … Version 30 grouper for UB-04 claims? … The condition or
nature of the sequela [illness or injury that caused the sequela] is.
Aug 6, 2014 … For a listing of billing instructions for all Medicaid …. of service on or after October
1, 2015 only ICD-10 codes will be accepted. …. Claim Form Completion
Instructions: CMS-1450 (UB-04) completion requirements for … Use value code
80 to report covered days, 81 to report non-covered days, 82 to report co-.
listing of the recipient name on the South Dakota Medicaid file. …. required to use
the official UB-04 (CMS-1450) claim form printed in red OCR ink and …. It is
provided in response to a life-threatening condition; to treat pain, injury, illness, or