http://www.vbh-pa.com/provider/info/claimsdept/UB04_Type_of_Bill_Codes.pdf
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
|
| 2
nd 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
|
| 2
nd 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
|