UB-04/CMS-1450 Reference Material
Type of Bill Codes (Field 4)
This is a three-digit code; each digit is defined below.
| UB-04/CMS-1450 Reference Material | |
| Type of Bill Codes (Field 4) | |
| This is a three-digit code; each digit is defined below. | |
| 1st Digit – Type of Facility | Code |
| Hospital | 1 |
| Skilled Nursing Facility | 2 |
| Home Health | 3 |
| Christian Science (Hospital) | 4 |
| Christian Science (Extended Care) | 5 |
| Intermediate Care | 6 |
| Clinic | 7 |
| 2nd Digit – Bill Classifications (Excluding Clinics & Special Facilities) | Code |
| Inpatient | 1 |
| Outpatient | 3 |
| Other (For Hospital Referenced Diagnostic Services, or Home Health Not Under a Plan of Treatment) | 4 |
| Intermediate Care, Level I | 5 |
| Intermediate Care, Level II | 6 |
| Intermediate Care, Level III | 7 |
| Swing Beds | 8 |
| 2nd Digit – Bill Classifications (Clinics Only) | Code |
| Rural Health | 1 |
| Hospital Based or Independent Renal Dialysis Center | 2 |
| Free Standing | 3 |
| Other Rehabilitation Facility (ORF) | 4 |
| Other | 9 |
| 2nd Digit – Bill Classifications (Special Facility Only) | Code |
| Hospice (Non-Hospital Based) | 1 |
| Hospice (Hospital Based) | 2 |
| Ambulatory Surgery Center (ASC) | 3 |
| Freestanding Birthing Center | 4 |
| 3rd Digit – Frequency | Code |
| Admit through Discharge Claim | 1 |
| Interim – First Claim | 2 |
| Interim – Continuing Claims | 3 |
| Interim – Last Claim | 4 |
| Late Charge only | 5 |
| Adjustment of Prior Claim | 6 |
| Replacement of Prior Claim | 7 |
| Void/Cancel of Prior Claim | 8 |
| Sex Codes (Field 15) | Code |
| Male | M |
| Female | F |
| Unknown | U |
| Marital Status Codes (Field 16) | Code |
| Single | S |
| Married | M |
| Legally Separated | X |
| Divorced | D |
| Widowed | W |
| Unknown | U |
| Life Partner | P |
| Type of Admission Codes (Field 19) | Code |
| Emergency | 1 |
| Urgent | 2 |
| Elective | 3 |
| Newborn | 4 |
| Information Not Available | 9 |
| Source of Admission Codes Except Newborns (Field 20) | Code |
| Physician Referral | 1 |
| Clinic Referral | 2 |
| HMO Referral | 3 |
| Transfer from a Hospital | 4 |
| Transfer from a Skilled Nursing Facility (SNF) | 5 |
| Transfer from Another Health Facility | 6 |
| Emergency Room | 7 |
| Court/Law Enforcement | 8 |
| Information Not Available | 9 |
| Transfer from Psych Substance Abuse or Rehab Hospital | 10 |
| Transfer from a Critical Access Hospital | 11 |
| Additional Source of Admission Codes for Newborns (Field 20) | Code |
| Normal Delivery | 1 |
| Premature Delivery | 2 |
| Sick Baby | 3 |
| Extramural Birth | 4 |
| Information Not Available | 5 |
| Patient Status Codes (Field 22) | Code |
| Discharged to Home or Self-Care (Routine Discharge) | 01 |
| Discharged/Transferred to Another Short-Term General Hospital | 02 |
| Discharged/Transferred to an SNF | 03 |
| Discharged/Transferred to an Intermediate Care Facility (ICF) | 04 |
| Discharged/Transferred to Another Type of Institution (Including Distinct Parts) or Referred for Outpatient Services to Another Institution | 05 |
| Discharged/Transferred to Home Under Care of Organized Home Health Service Organization | 06 |
| Left Against Medical Advise or Discontinued Care | 07 |
| Discharged/Transferred to Home Under Care of Home IV Therapy Provider | 08 |
| Admitted as an Inpatient to this Hospital | 09 |
| Expired (or Did Not Recover-Christian Science Patient) | 20 |
| Still a Patient or Expected to Return for Outpatient Services | 30 |
| Still Patient to be Defined at State Level, if Necessary | 31-39 |
| Expired at Home (for Hospice Care Only) | 40 |
| Expired in a Medical Facility such as a Hospital, SNF, ICF or Freestanding Hospice (for Hospice Care Only) | 41 |
| Expired, Place Unknown (for Hospice Care Only) | 42 |
| Discharged to Hospice-Home | 50 |
| Discharged to Hospice-Medical Facility | 51 |
| Release of Information Indicator Codes (Field 52) | Code |
| Yes | Y |
| Restricted or Modified Release | R |
| No Release | N |