The Official UB-04 Data Specifications Manual 2025, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing Committee (NUBC).
It contains updated specifications for the data elements and codes included on the UB-04 claim form and is used in the electronic HIPAA Institutional 837 Health Care Claim transaction standard.
Subscription to the UB-04 Manual is available through single-user and multi-user licenses.
Please visit the NUBC website for more information.
| Bill Type Codes |
|---|
| 011X Hospital Inpatient (Part A) |
| 012X Hospital Inpatient Part B |
| 013X Hospital Outpatient |
| 014X Hospital Other Part B |
| 018X Hospital Swing Bed |
| 021X SNF Inpatient |
| 022X SNF Inpatient Part B |
| 023X SNF Outpatient |
| 028X SNF Swing Bed |
| 032X Home Health |
| 034X Home Health (Part B Only) |
| 041X Religious Nonmedical Health Care Institutions |
| 043X Religious Nonmedical Health Care Institutions- Outpatient Services |
| 065X Intermediate Care - Level I |
| 066X Intermediate Care - Level II |
| 071X Clinical Rural Health |
| 072X Clinic ESRD |
| 074X Clinic - Outpatient Rehabilitation Facility (ORF) |
| 075X Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF) |
| 076X Community Mental Health Centers |
| 077X Federally Qualified Health Centers |
| 081X Nonhospital based hospice |
| 082X Hospital based hospice |
| 083X Hospital Outpatient (ASC) |
| 085X Critical Access Hospital |
| 087x Freestanding Non-residential Opioid Treatment Program |
| Type of bill frequency codes |
|---|
| 0 Non-payment/zero |
| 1 Admit through discharge claim |
| 2 Interim - first claim |
| 3 Interim - continuing claim |
| 4 Interim - last claim |
| 5 Late charge(s) only |
| 7 Replacement of prior claim |
| 8 Void/Cancel of prior claim |
| 9 Final Claim for a home health PPS episode |
| A Admission/election notice |
| B Hospice/CMS Coordinated Care Demonstration/Religious Non-Medical Health Care Institution/Centers of Excellence Demonstration/Provider Partnerships Demonstration |
| C Hospice change of provider notice |
| D Hospice/CMS Coordinated Care Institution/Centers of Excellence Demonstration/Provider Partnerships Demonstration Void/Cancel |
| E Hospice change of ownership |
| F Beneficiary initiated adjustment claim |
| G CWF initiated adjustment claim |
| H CMS initiated adjustment |
| I Intermediary adjustment claim |
| J Initiated adjustment claim - other |
| K OIG initiated adjustment claim |
| M MSP initiated adjustment claim |
| O Nonpayment/zero claims |
| P QIO adjustment claim |
| Q Claim submitted for reconsideration/reopening outside of timely limits |
| X Void/Cancel a prior abbrev. Encounter submission |
| Y Replacement a prior abbrev. Encounter submission |
| Z New abbrev. encounter submission |
| Priority (Type) of Admission/Visit |
|---|
| 1 Emergency |
| 2 Urgent |
| 3 Elective |
| 4 Newborn |
| 5 Trauma |
| 6 Information not available |
| Point of Origin for Admission or Visit |
|---|
| 1 Non-health care facility point of origin |
| 2 Clinic or physician's office |
| 4 Transfer from a hospital (different facility) |
| 5 Transfer from a SNF, ICF or ALF |
| 6 Transfer from another health care facility |
| 8 Court/law enforcement |
| 9 Information not available |
| D Transfer from hospital inpatient in the same facility resulting in a separate claim to the payer |
| E Transfer from ASC |
| F Transfer from hospice facility |
| G Transfer from a Designated Disaster Alternative Care Site |
| FL 17 - Patient Status |
|---|
| 01 Discharged to home or self care (Routine discharge) |
| 02 Discharged/transferred to a short-term general hospital for inpatient care |
| 03 Discharged/transferred to SNF with Medicare certification in anticipation of Skilled Care |
| 04 Discharged/transferred to a facility that provides custodial or supportive care |
| 05 Discharged/transferred to a designated cancer center or children's hospital |
| 06 Discharged/transferred to home/under HHA care in anticipation of covered skilled care |
| 07 Left against medical advice or discontinued care |
| 09 Admitted as inpatient to this hospital |
| 21 Discharged/transferred to court/law enforcement |
| 30 Still patient |
| 40 Expired at home |
| 41 Expired in medical facility |
| 42 Expired place unknown |
| 43 Discharged/transferred to federal health care facility |
| 50 Hospice - home |
| 51 Hospice - medical facility providing hospice level of care |
| 61 Discharged/transferred to hospital-based Medicare approved swing bed |
| 62 Discharged/transferred to IRF including rehab distinct part units of a hospital |
| 63 Discharged/transferred to Medicare certified LTCH |
| 64 Discharged/transferred to nursing facility certified under Medicaid but not under Medicare |
| 65 Discharged/transferred to psychiatric hospital or psych dist part unit of a hospital |
| 66 Discharged/transferred to a CAH |
| 69 Discharged/transferred to a designated disaster alternative care site |
| 70 Discharged/transferred to another type of health care institution not defined elsewhere in this code list |
| 81 Discharged to home or self care with a planned acute care hospital inpatient readmission |
| 82 Discharged/transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission |
| 83 Discharged/transferred to a SNF with Medicare certification with a planned acute care hospital inpatient readmission |
| 84 Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission |
| 85 Discharged/transferred to a designated cancer center or children's hospital with a planned acute care hospital inpatient readmission |
| 86 Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission |
| 87 Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission |
| 88 Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission |
| 89 Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission |
| 90 Discharged/transferred to an IRF including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission |
| 91 Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission |
| 92 Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission |
| 93 Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital with a planned acute care hospital inpatient readmission |
| 94 Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission |
| 95 Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission.Ocurrence Code 55 also required |
| FL 18-28 - Condition Codes |
|---|
| 01 Military service related |
| 02 Condition is employment related |
| 03 Patient covered by insurance not reflected here |
| 04 Information only bill |
| 05 Lien has been filed |
| 06 ESRD 1st 30 mo. entitlement, covered by EGHP |
| 07 Treatment of non-terminal condition - hospice |
| 08 Would not provide other insurance info |
| 09 Neither patient nor spouse is employed |
| 10 Patient and/or spouse employed, no EGHP |
| 11 Disabled beneficiary but no LGHP |
| 17 Patient is homeless |
| 18 Maiden name retained |
| 19 Child retains mother's name |
| 20 Beneficiary requested billing |
| 21 Billing for denial notice |
| 22 Patient on multiple drug regimen |
| 23 Home care giver available |
| 24 Home IV patient receiving home health services |
| 25 Patient is a non-U.S. resident |
| 26 VA patient chooses Medicare facility |
| 27 Patient referred to sole community hospital for diagnostic lab test |
| 28 Patient/spouse EGHP secondary to Medicare |
| 29 Disabled bene/fam LGHP secondary to Medicare |
| 30 Qualifying clinical trials |
| 31 Patient is a student, full-time |
| 32 Patient is a student, coop/work-study prog |
| 33 Patient is a student, full-time - night |
| 34 Patient is a student, part-time |
| 36 General care patient in special unit |
| 37 Ward accommodation at patient request |
| 38 Semi-private room not available |
| 39 Private room medically necessary |
| 40 Same day transfer |
| 41 Partial hospitalization |
| 42 Continue care plan not related to inpat hospitalization |
| 43 Continue care, not within prescribed post-discharge window |
| 44 Inpatient admission changed to outpatient |
| 45 Ambiguous gender category |
| 46 Non-availability statement on file |
| 47 Transfer from another home health |
| 48 Psychiatric residential treatment centers for children and adolescents |
| 49 Product replacement within product lifecycle |
| 50 Product replacement for known recall of a product |
| 51 Attestation of unrelated outpatient non-diagnostic services |
| 52 Out of hospice service area |
| 53 Initial placement of a medical device provided as part of a clinical trial or a free sample |
| 54 No skilled home health visits in billing period |
| 55 SNF bed not available |
| 56 Medical appropriateness |
| 57 SNF readmission |
| 58 Terminated Medicare Advantage enrollee |
| 59 Non-primary ESRD facility |
| 60 Day outlier |
| 61 Cost outlier |
| 66 Provider does not wish cost outlier payment |
| 67 Beneficiary elects not to use LTR days |
| 68 Beneficiary elects to use LTR days |
| 69 IME/DGME/N&AH payment only |
| 70 Self-administered anemia mgmt. drug |
| 71 Full care in unit (dialysis) |
| 72 Self care in unit (dialysis) |
| 73 Self care training (dialysis) |
| 74 Home dialysis |
| 75 Home dialysis - 100% reimbursement |
| 76 Back-up in facility dialysis |
| 77 Provider accepts as payment in full |
| 78 New coverage not implemented by managed care plan |
| 79 CORF services provided offsite |
| 80 Home Dialysis - nursing facility |
| 81 C-Sections/Inductions < 39 weeks - medical necessity |
| 82 C-Sections/Inductions < 39 weeks - elective |
| 83 C-Sections/Inductions 39 weeks or greater |
| 84 Dialysis for acute kidney injury |
| 85 Delayed recertification of hospice terminal illness |
| 86 Additional hemodialysis treatments with medical justification |
| 89 Opioid Treatment Program/Indicates claim is for opioid treatment program services |
| 90 Service provided as part of an Expanded Access approval |
| 91 Service provided as part of an Emergency Use Authorization |
| A0 TRICARE external partnership prog |
| A1 EPSDT/CHAP |
| A2 Physically handicapped children's prog |
| A3 Special federal funding |
| A4 Family planning |
| A5 Disability |
| A6 Vaccines/Medicare 100% payment |
| A9 Second opinion surgery |
| AA Abortion - rape |
| AB Abortion - incest |
| AC Abortion - genetic defect |
| AD Abortion - life endangering condition |
| AE Abortion - not life endangering |
| AF Abortion - emotional health |
| AG Abortion - social/economic Reasons |
| AH Elective abortion |
| AI Sterilization |
| AJ Payer responsible for co-payment |
| AK Air ambulance required |
| AL Specialized treatment/bed unavailable |
| AM Non-emergency medically necessary stretcher transport required |
| AN Pre admission screening not required |
| B0 Medicare coord. care demo claim |
| B1 Beneficiary is ineligible for demo prog |
| B2 CAH ambulance attestation |
| B3 Pregnancy indicator |
| B4 Admission unrelated to discharge on same day |
| BP Gulf oil spill of 2010 |
| C1 Approved as billed (QIO) |
| C2 Automatic approval on focused review (QIO) |
| C3 Partial approval (QIO) |
| C4 Admission/services denied (QIO) |
| C5 Post-payment review applicable (QIO) |
| C6 Admission preauthorization (QIO) |
| C7 Extended authorization (QIO) |
| D0 Changes to service dates |
| D1 Changes to charges |
| D2 Changes to revenue codes/HCPCS/HIPPS rate codes |
| D3 Second or subsequent interim PPS bill |
| D4 Change in ICD procedure codes |
| D5 Cancel to correct insured's/provider ID |
| D6 Cancel only to repay dup or OIG overpayment |
| D7 Medicare as secondary |
| D8 Medicare as primary |
| D9 Other changes |
| DR Disaster related |
| E0 Change in patient status |
| G0 Distinct medical visit |
| H0 Delayed filing: statement of intent submitted |
| H2 Discharge by a hospice provider for cause |
| H3 Reoccurrence of GI bleed comorbid |
| H4 Reoccurrence of Pneumonia comorbid |
| H5 Reoccurrence of Pericarditis comorbid |
| P1 Do not resuscitate order (DNR) |
| P7 Direct inpat admission from ED |
| R1 Request for reopening - math or computational mistakes |
| R2 Request for reopening - inaccurate data entry |
| R3 Request for reopening - misapplication of a fee schedule |
| R4 Request for reopening - computer errors |
| R5 Request for reopening - incorrectly identified dup claim |
| R6 Request for reopening - other clerical and minor errors and omissions |
| R7 Request for reopening - corrections other than clerical errors |
| R8 Request for reopening - new and material evidence |
| R9 Request for reopening - faulty evidence |
| W0 UMWA demonstration indicator |
| W2 Duplicate of original bill |
| W3 Level I appeal |
| W4 Level II appeal |
| W5 Level III appeal |
| FL 31-34 - Occurrence Codes |
|---|
| 01 Accident/medical coverage |
| 02 No-fault insurance, including auto |
| 03 Accident, tort liability |
| 04 Accident, employment-related |
| 05 Accident/no medical or liability cov |
| 06 Crime victim |
| 09 Start of infertility treatment |
| 10 Last menstrual period |
| 11 Onset of symptoms/illness |
| 12 Date of onset, chronically dependent individual |
| 16 Date of last therapy |
| 17 Date outpatient occupational therapy plan established/last reviewed |
| 18 Date of retirement (patient/bene) |
| 19 Date of retirement (spouse) |
| 20 Date guarantee of payment began |
| 21 Date UR notice received |
| 22 Date active care ended |
| 24 Date insurance denied |
| 25 Date benefits terminated by primary payer |
| 26 Date SNF bed available |
| 27 Date hospice cert or recert |
| 28 Date CORF plan estab/last reviewed |
| 29 Date outpatient physical therapy plan estab/last reviewed |
| 30 Date outpatient speech language pathology plan estab/last reviewed |
| 31 Date bene notified intent to bill (accom) |
| 32 Date bene notified intent to bill (proc/treat) |
| 33 First day of ESRD coordination covered by EGHP |
| 34 Date of election of extended care |
| 35 Date physical therapy started |
| 36 Date inp hosp disch, covered transplant |
| 37 Date inp hosp disch, non-covered transplant |
| 38 Date started for home IV therapy |
| 39 Date disch/on a cont/course of IV therapy |
| 40 Scheduled date of admission |
| 41 Date of first test/pre-admission testing |
| 42 Date of discharge |
| 43 Scheduled date of canceled surgery |
| 44 Date occupational therapy started |
| 45 Date speech therapy started |
| 46 Date cardiac rehab started |
| 47 First full day of cost outlier |
| 50 Assessment date |
| 51 Date of last Kt/V reading |
| 52 Medical certification/recert date |
| 54 Physician follow-up date |
| 55 Date of Death |
| A1 Birth date, insured A |
| A2 Effective date, insured A policy |
| A3 Benefits exhausted - Payer A |
| A4 Split bill date |
| FL 35-36 - Occurrence Span Codes |
|---|
| 70 Qualifying stay dates for SNF only |
| 71 Prior stay dates |
| 72 First/last visit dates |
| 73 Benefit eligibility period |
| 74 Noncovered level of care or leave of absence (LOA) |
| 75 SNF level of care dates |
| 76 Patient liability period |
| 77 Provider liability period |
| 78 SNF prior stay dates |
| 80 Prior same-SNF stay dates for payment ban purposes |
| 81 Antepartum Days at Reduced Level of Care |
| M0 QIO/UR approved stay dates |
| M1 Provider liability - no utilization |
| M2 Inpatient respite dates |
| M3 ICF level of care |
| M4 Residential level of care |
| FL 39-41 - Value Codes |
|---|
| 01 Most commom semi-private rate |
| 02 Hospital has no semi-private rooms |
| 04 Professional component charges, combined billed |
| 05 Professional component included, billed to carrier |
| 06 Blood deductible |
| 08 LTR amount, 1st calendar year |
| 09 Co-ins amount, 1st calendar year |
| 10 LTR amount, 2nd calendar year |
| 11 Co-ins amount, 2nd calendar year |
| 12 Working aged bene/spouse with EGHP |
| 13 ESRD bene in Medicare coord period with EGHP |
| 14 No-fault, including auto/other ins |
| 15 Worker's compensation |
| 16 PHS or other federal agency |
| 21 Catastrophic |
| 22 Surplus |
| 23 Recurring monthly income |
| 24 Medicaid rate code |
| 25 Offset to pt-pymnt amnt - RX drugs |
| 26 Offset to pt-pymnt amnt - hearing & ear |
| 27 Offset to pt-pymnt amnt - vision & eye |
| 28 Offset to pt-pymnt amnt - dental services |
| 29 Offset to pt-pymnt amnt - chiropractic |
| 30 Pre-admission testing |
| 31 Patient liability amount |
| 32 Multiple patient ambulance transport |
| 33 Offset to pt-pymnt amnt - podiatric |
| 34 Offset to pt-pymnt amnt - other medical |
| 35 Offset to pt-pymnt amnt - health ins. Prem |
| 37 Units of blood furnished |
| 38 Blood deductible units |
| 39 Units of blood replaced |
| 40 New coverage not implemented by HMO |
| 41 Black lung |
| 42 VA |
| 43 Disabled bene under 65 with LGHP |
| 44 Amount provider agreed to accept from primary payer |
| 45 Accident hour |
| 46 Number of grace days |
| 47 Any liability insurance |
| 48 Hemoglobin reading |
| 49 Hematocrit reading |
| 50 Physical therapy visits |
| 51 Occupational therapy visits |
| 52 Speech therapy visits |
| 53 Cardiac rehab visits |
| 54 Newborn birth weight in grams |
| 55 Eligibility threshold for charity care |
| 56 Skilled nursing visits hours (HHA) |
| 57 HH aide, home visit hours (HHA) |
| 58 Arterial blood gas |
| 59 Oxygen saturation |
| 60 HHA branch MSA |
| 61 Arterial blood gas |
| 66 Medicaid spend down amount |
| 67 Peritoneal dialysis (HHA) |
| 68 EPO - drug |
| 69 State charity care percent |
| 80 Covered days |
| 81 Non-covered days |
| 82 Co-insurance days |
| 83 Lifetime reserve days |
| 84 Shorter duration, hemodialysis (Effective 7/1/17) |
| A0 Special ZIP code reporting |
| A1 Deductible, payer A |
| A2 Co-insurance, payer A |
| A3 Estimated responsibility, payer A |
| A4 Cvrd self-administrable drugs/emergency |
| A Cvrd self-administrable drugs - not self administrable form/situation |
| A6 Cvrd self-administrable drugs - study |
| A7 Co-payment payer A |
| A8 Patient weight |
| A9 Patient height |
| AA Regulatory surcharges, assessments, allowances or health care related taxes payer A |
| AB Other assessments or allowances (e.g., medical education) payer A |
| Use B1-GB as A1-A3 and A7-AB for other payers |
| D6 - The total number of minutes of dialysis provided during the billing period |
| Y1 Part A demonstration payment |
| Y2 Part B demonstration payment |
| Y3 Part B coinsurance |
| Y4 Conventional provider payment |
| Y5 Part B deductible |
| FL 59 - Patient Relationship to Insured |
|---|
| 01 Spouse |
| 18 Self |
| 19 Child |
| 20 Employee |
| 21 Unknown |
| 39 Organ donor |
| 40 Cadaver donor |
| 53 Life partner |
| GS Other relationship |
| Revenue Codes |
|---|