What Is UB-04 form?
The UB-04 (also known as CMS-1450) is the standard paper claim form used by institutional providers (hospitals, SNFs, home health, hospice) to bill Medicare and other payers; its electronic equivalent is the 837I (Institutional) HIPAA EDI transaction.
- Charge description master (CDM) maintenance keeps revenue code, HCPCS, and pricing aligned.
UB-04 form
Also known as: CMS-1450; Uniform Billing form; UB-04/CMS-1450
The UB-04 (also known as CMS-1450) is the standard paper claim form used by institutional providers (hospitals, SNFs, home health, hospice) to bill Medicare and other payers; its electronic equivalent is the 837I (Institutional) HIPAA EDI transaction.
Definition
Maintained by the National Uniform Billing Committee (NUBC), the UB-04 contains 81 form locators covering patient demographics, admission/discharge dates, type of bill (TOB), revenue codes, HCPCS/CPT codes, units, charges, occurrence and value codes, condition codes, attending physician NPI, and diagnosis codes (ICD-10-CM principal and secondary, plus ICD-10-PCS for inpatient procedures). The 837I electronic transaction uses ASC X12N standards. UB-04/837I is required for hospital inpatient (paid via MS-DRG), hospital outpatient (paid via OPPS APCs), critical access hospitals, SNFs, home health, hospice, and FQHC/RHC claims.
Example
A hospital inpatient admission for total knee replacement uses UB-04/837I with TOB 111 (inpatient admit through discharge), revenue code 0360 (operating room), CPT 27447 (or ICD-10-PCS 0SRD0J9 if reporting at the procedure level), and primary diagnosis M17.11 (right knee primary OA). The orthopedic surgeon's professional fee for the same case is billed separately on a CMS-1500.
Common Misconceptions
Hospital outpatient and ED claims also use UB-04, not CMS-1500 — even though the procedures are coded with CPT/HCPCS. The form determines payment system: UB-04 routes to OPPS/IPPS rules; CMS-1500 routes to MPFS rules.
Practical Application
Hospital revenue cycle teams must understand the relationship between revenue codes (driving the cost-center accumulator), HCPCS/CPT codes (driving APC assignment), and ICD-10-CM/PCS codes (driving DRG assignment for inpatient and medical necessity for outpatient). Charge description master (CDM) maintenance keeps revenue code, HCPCS, and pricing aligned.
Related Terms
CMS-1500 form
The CMS-1500 is the standard paper claim form used by non-institutional providers (physicians, NPPs, suppliers) to bill Medicare and most commercial payers; its electronic equivalent is the 837P (Professional) HIPAA EDI transaction.
Read definition arrow_forwardX12 (HIPAA EDI)
ASC X12 is the standards body whose X12N subcommittee develops the HIPAA-named electronic data interchange transactions for healthcare administrative data: 837 (claims), 835 (remittance), 270/271 (eligibility), 276/277 (claim status), 278 (prior auth), and 834 (enrollment).
Read definition arrow_forwardDRG (Diagnosis-Related Group)
A DRG is the inpatient hospital classification system that groups admissions with similar clinical characteristics and resource use into a single payment category; CMS uses MS-DRGs to pay hospitals under the IPPS for Medicare inpatient stays.
Read definition arrow_forwardAPC (Ambulatory Payment Classification)
An APC is the hospital outpatient classification system used by CMS under the Outpatient Prospective Payment System (OPPS) to group similar outpatient services for prospective payment to hospitals.
Read definition arrow_forwardICD-10-PCS
ICD-10-PCS is the U.S. inpatient hospital procedural code set maintained by CMS, with seven-character alphanumeric codes used exclusively to report procedures performed during inpatient hospital admissions for billing under MS-DRGs.
Read definition arrow_forwardWhere This Applies on MedPrecision
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