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what is ub04 condition code 38

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CMS Manual System – CMS.gov

www.cms.gov

Oct 5, 2009 … SUBJECT: New Patient Discharge Status Code 21 to Define Discharges or … B.
Policy: Field Locator 17 of the UB-04 and its electronic equivalence is a …. FLs 18
, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28 – Condition Codes …. neither code 37
nor code 38 applies, and the provider is not paid under PPS, the.

Uniform Billing (UB-04) – CMS.gov

www.cms.gov

23, 2007 all institutional paper claims must use the UB-04. The UB-92 will no ….
maximum number of the UB-04 codes (value codes, condition codes, occurrence
codes occurrence ….. Moved to FL64. FL38 Responsible Party Name/Address. 1.

Medicare Claims Processing Manual – CMS.gov

www.cms.gov

41 Value Codes are being updated to include one new condition code and two
new … A. Background: The National Uniform Billing Committee (NUBC) has ……
neither code 37 nor code 38 applies, and the provider is not paid under PPS, the.

Medicare Claims Processing Manual Crosswalk – CMS.gov

www.cms.gov

This form, also known as the UB-04, is a uniform institutional provider bill suitable
for … (NUBC) maintains lists of approved coding for the form. …. FL35 Occurrence
Span Code/From/Through … FL38 Responsible Party Name/Address. 1 AN.

UB04 Billing Guide – Inpatient Hospitals 01-30-2017 – Pennsylvania …

www.dhs.pa.gov

Jan 30, 2017 … UB-04 Billing Guide for PROMISe™ Inpatient Hospitals. Purpose of the …..
Occurrence Codes, please refer to the UB-04 Desk · Reference … Do not
complete this Form Locator. 38. Unlabeled. (Internal Control. Number). LB.

UB-04 Billing Guide for PROMISe™ Outpatient Hospitals

www.dhs.pa.gov

Jan 30, 2017 … Condition Codes, please refer to the UB-04 Desk · Reference … 38. Unlabeled.
LB. Do not place anything in this area of the claim form. 39–41.

UB04 Hospital Billing Instructions – Maryland Medicaid – Maryland.gov

mmcp.dhmh.maryland.gov

32. FL 35-36. Occurrence Span Codes and Dates. 36. FL 37. NOT USED. 38. FL
38 … UB04 HOSPITAL ADDENDUM INSTRUCTIONS – ADMINISTRATIVE DAY …

UB04 Billing Instructions Guide – Health PAS Online – Maine.gov

mainecare.maine.gov

Aug 30, 2016 … UB 04 Billing Instructions Guide … the data contained within as required by law.
Access …. FL 31 – 34: OCCURRENCE CODES AND DATES. … FL 38:
RESPONSIBLE PARTY NAME AND ADDRESS (CLAIM ADDRESSEE) .

ODM Hospital Billing Guidelines – Ohio Department of Medicaid

medicaid.ohio.gov

Oct 1, 2015 … Language was revised regarding Condition Code C3. …. Occurrence Span
Codes and Dates. 37. Reserved for Assignment by the NUBC. 38.

UB-04 Claim filing instructions, Outpatient Hospital, Hospital Billing …

dss.mo.gov

an electronic version of the UB-04 claim form for outpatient services are … 18-24.
** Condition Codes. Enter the applicable two-character condition code. … 37
Unlabeled Field. Leave blank. 38. Responsible Party Name. Leave blank.

TABLE OF CONTENTS – SCDHHS.gov

www.scdhhs.gov

Dec 1, 2016 … National Drug Code (NDC) Billing Requirements for Outpatient Hospital. Setting .
…. 37. Electronic Funds Transfer (EFT) …………………………………………………………… 38
….. Medicaid claims must be filed on the UB-04 claim form. Alternative forms are
….. SCDHHS has implemented the use of Condition Code B4.

471-000-71 appendix – Nebraska Department of Health and Human …

dhhs.ne.gov

These instructions can be used in combination with the CMS-1450 (UB-04) claim
form … Use Occurrence Span Code 70 to report nursing facility Medicare Days …
38. Responsible Party Name and Address. Not Used. 39-41. Value Codes and …

OWCP-04 – United States Department of Labor

www.dol.gov

38. 39. 40. 41. 42 REV. CD. 43 DESCRIPTION. 45 SERV. DATE. 46 SERV.
UNITS … 71 PPS. CODE. QUAL. LAST. LAST. National Uniform. Billing
Committee. NUBC™ … OWCP uses a condition-specific fee schedule based on
the Prospective.

UB-04 – OK.gov

www.ok.gov

38. 39. 40. 41. 42 REV. CD. 43 DESCRIPTION. 45 SERV. DATE. 46 SERV.
UNITS …. If Occurrence Span Code entered a Corresponding date must be
entered.

Dialysis Billing Manual – Colorado.gov

www.colorado.gov

Hospitalization is required for a covered medical condition and …. All code values
listed in the NUBC UB-04 Reference Manual for each form locator may not be ….
Form Locator and. Label. Completion Format. Instructions. 38. Responsible.

Inpatient/Outpatient Hospital Billing Manual – Colorado.gov

www.colorado.gov

Refer to the Colorado Medical Assistance Program UB-04 Revenue Code Table
… management of, the prior stay's medical condition, the hospital must bill these …

UB-04 Billing Guide – Mass.Gov

www.mass.gov

The type of bill codes and UB-04 claim frequency type code values for …
Condition Codes Enter the code(s) used to identify conditions or events relating
to this bill … All Other Provider Types: Not required. 37. (Unnamed). Not used. 38.

Medi-Cal Billing and Reconciliation Webinar Codes 18, 19 & 20

www.dhcs.ca.gov

Apr 23, 2013 … Enter three key facts in Remarks, Fld., 80, on the UB04 claim form. 1. Whether …
Do not complete Condition Codes Fields 18 – 28 for Medicare Status …. Recipient
is not eligible for the month of service billed. April 23, 2013. 38 …

(CMS-1450) (UB-04) – CT.gov

www.ct.gov

c d. ADMISSION. CONDITION CODES … d. LAST. FIRST. UB-04 CMS-1450 … 38
. 39. 40. 41. 42 REV. CD. 43 DESCRIPTION. 45 SERV. DATE. 46 SERV. UNITS.

UB-04 Paper Claim Form Billing Instructions – North Dakota State …

www.nd.gov

Sep 1, 2016 … Condition Codes: Enter conditions or events relating to this claim. 29 … 37. Not
Required. Reserved for assignment by the NUBC. 38.

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what occurrence code to use when patient has physical therapy and occupational on a ub04

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SNF Billing Reference – CMS.gov

www.cms.gov

codes and descriptions; and/or making any commercial use of UB-04 Manual …
The American Hospital Association (the “AHA”) has not reviewed, and is not ….
licensed practical nurses, physical therapists, occupational therapists, and
speech-language … services or for a new condition that arose during the SNF
care for that …

MM4047 – CMS.gov

www.cms.gov

Feb 16, 2013 … Occupational Therapy … The provider will use an occurrence span code 74 (
Leave of … repetitive services that have the same date of service as a repetitive
service (even if both the non-repetitive … A physical therapy treatment (which is a
repetitive service because it is reported under a revenue code.

Medicare Claims Processing Manual – CMS.gov

www.cms.gov

lieu of standard Medicare coverage for treatment and management of their …
Likewise, if a “new patient” claim for HCPCS codes 99201-99205 has been …
shall reject the claim and the contractor shall deny the bill and use the … with an
occurrence span code 77, and charges for all claim lines reporting ……
Occupational.

UB04 Billing Instructions Guide – Health PAS Online – Maine.gov

mainecare.maine.gov

Aug 30, 2016 … This Maine Health PAS Online Portal is for the use of authorized users only.
Users of the …. FL 31 – 34: OCCURRENCE CODES AND DATES.

UB-04 Billing Guide for PROMISe™ Inpatient Rehabilitation …

www.dhs.pa.gov

Jan 30, 2017 … The Patient Protection and Affordable Care Act (ACA) added requirements for …
All inpatient hospital claims must have a MA enrolled ordering or prescribing ….
Condition Codes, please refer to the UB-04 Desk … in this Form Locator using
Value Code 66. …. Physical Therapy. 43X. Occupational Therapy.

Home Health Billing Manual – Colorado.gov

www.colorado.gov

In addition, the UB-04 Certification document must be completed and …. o
Client's diagnoses that will be addressed by Home Health, using V-codes
whenever … Do not render or bill for services until the PAR has been processed.
…. o Pediatric clients may also receive physical therapy, occupational therapy
and speech.

Hospital Billing Book, complete – Missouri Department of Social …

dss.mo.gov

Jun 21, 2013 … Section 5: UB-04 Claim Filing Instructions – Outpatient Hospital. Section 6:
Revenue Codes – Outpatient Hospital Facility … not use either of these numbers
for requests for pre-certifications of MRI, MRA, … Services, has an Internet service
for MO HealthNet providers, …… 0439 Other Occupational Therapy.

UB04 Hospital Billing Instructions – Maryland Medicaid – Maryland.gov

mmcp.dhmh.maryland.gov

Patient address, city, State, zip code, and county code … Occurrence Span Codes
and Dates …. Physical Therapy. 84. 043x. Occupational Therapy … The UB-04 is
a uniform institutional bill suitable for use in billing multiple third party … aware
that Maryland Medicaid has a maximum line item allowance on the UB04 of 50 …

471-000-83 appendix – Nebraska Department of Health and Human …

dhhs.ne.gov

The instructions in this appendix apply when billing Nebraska Medicaid, also
known as the … have Medicare Part A coverage or who have exhausted
Medicare Part A … Claim Form Completion Instructions: CMS-1450 (UB-04)
completion … HCPCS procedure codes are required on inpatient claims for “other
therapeutic.

Chapter IV. Billing Iowa Medicaid – Iowa Department of Human …

dhs.iowa.gov

Jan 1, 2016 … INSTRUCTIONS FOR COMPLETING THE UB-04 CLAIM FORM . ….. Providers
have 365 days from the date of service to submit a claim. …. reported using value
codes in fields …. 41 Hospice patient died at hospital ….. therapy. 9 Other
respiratory services. 42X. Physical Therapy … occupational therapy –.

DEPARTMENT OF LICENSING AND … – State of Michigan

www.michigan.gov

Dec 26, 2014 … bills of any health facility or health care provider which have been … the
diagnosis or condition for which the patient is being treated, the health facility …..
for a particular procedure code using data available from the ….. Occupational
therapy means physical treatment provided by an occupational therapist.

Private Rehabilitative Therapy And Audiological Services

www.scdhhs.gov

Jul 8, 2011 … Private Rehabilitative Therapy & Audiological Services Manual …. Updated
Physical and Occupational Therapy Services ….. Deleted policy to use Medicaid
legacy provider … December 10, 2010 – Reporting Patient Liability ….. Updated
field numbers for occurrence codes on. UB-04. • Replaced sample …

Spina Bifida Guide – Department of Veterans Affairs

www.va.gov

Please read it carefully prior to using your benefits. Changes that take …. code(s),
equipment/supply code(s), diagnosis code(s) and place of service … medically
necessary because of the beneficiary's physical or mental condition ….
Occupational therapy … when the patient's condition would have permitted use of
regular.

Chapter A-200 Policy and Procedures For Medical … – Illinois.gov

www.illinois.gov

220.13 Smoking and Tobacco Use Cessation … A-260 Physical and
Occupational Therapy …. Procedure Code – A code from the CPT or HCPCS code
set. ….. condition of employment, may elect to have payment directed to the
employing … The patient's medical record must show that these requirements
have been met. All.

NH Medicaid Final Therapies PT OT ST Provider Manual

nhmmis.nh.gov

May 3, 2014 … These manuals are not designed for use by NH Medicaid members … Each
participating physical therapist, occupational therapist, and …. identify, prevent,
detect, and correct potential occurrences of fraud, … In addition, the provider may
also have their claims placed on a ….. 10 a-c Is Patient's Condition.

Chapter 9: Claims Processing and Payment – Arizona Department of …

dcs.az.gov

May 1, 2002 … Codes to Use . …. Inpatient Hierarchy for Processing UB-04 Claims . …. It is
important that CMDP has accurate billing information for providers on file. Please
… or the condition must be stabilized before returning to the state. … Therapy
treatment services for physical occupational or speech therapies (initial.

837 Health Care Claim – Institutional – Wisconsin Department of …

www.dhs.wisconsin.gov

All of these programs use the ForwardHealth interChange. … ForwardHealth has
determined that all providers, except for personal care ….. physical address on
file with Wisconsin Medicaid. ….. Condition. Code. Enter the condition code. 2300
QTY. Claim Quantity This ….. Occupational Therapy Assistant 224Z00000X.

National Hospital Care Survey Demonstration Projects: Traumatic …

www.cdc.gov

Sep 19, 2016 … occupational therapy received in follow-up outpatient visits were corrected …
elements such as intensive care use and diagnostic and physical … occurrence
of TBI because most TBIs … conducted by NCHS, has provided data ….. codes
are included in the record of a patient. These codes describe services.

Instructions and Guidelines090111–022113 – Illinois Workers …

www.iwcc.il.gov

Feb 21, 2013 … B. Base value, physical status modifier, time units, and qualifying circumstances
…. An Anesthesia fee schedule has been established using historical charge …..
on the UB-04 billing form the CPT/HCPCS and revenue codes are listed. … and
occupational therapy services in the aforementioned code range …

Tools for More Accurate Inpatient Cost Estimates with HCUP …

www.hcup-us.ahrq.gov

Table A1: Map of UB-04 Revenue Code to Cost-Center Clusters . … AF for the
patient's MS-DRG or CCS category to get a more accurate CCR and, … detailed
charges for every case, and not all hospitals have usable CMS … most
dependent on the relative use of routine bed unit services. ….. Physical/
Occupational Therapy.

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box 71 ub04 cms pps situational

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Medicare Claims Processing Manual Crosswalk – CMS.gov

www.cms.gov

This form, also known as the UB-04, is a uniform institutional provider bill suitable
for use in billing multiple ….. FL71 Prospective Payment System (PPS) Code. AN.
3. 2. FL72a …. and name, post office box number or RFD, city, State, and ZIP
Code. ….. FL 51A (Required), B (Situational), and C (Situational) – Health Plan ID
.

CMS Manual System – CMS.gov

www.cms.gov

Jun 11, 2007 … The Form CMS-1450 Part A claim form (UB-04) is a vehicle used to collect …
office box number or street name and number may be included. … Situational. …
2 Inpatient (Part B) – (For HHA non PPS claims, Includes HHA visits under a Part
….. 71. Full Care in Unit. The billing is for a patient who received.

CMS Manual System – CMS.gov

www.cms.gov

Mar 9, 2010 … SUBJECT: Point of Origin for Admission or Visit Codes Update to the UB-04 (
CMS-1450) Manual … equivalence is a required field on all institutional inpatient
claims …. Situational. … For HHAs under PPS, indicates an osteoporosis claim.
….. 71. Full Care in Unit. The billing is for a patient who received staff-.

CMS Manual System – CMS.gov

www.cms.gov

Jul 17, 2007 … Drug Rebate Data Submitted on Form UB 04 Paper Claims and Direct Data Entry
(DDE) Claims. … Prior to these requirements, the Revenue Description Field area
of the. UB-04 has ….. Assessment Date – used for billing SNF PPS (Bill Type … In
this situation, the provider bills the Medicare program for one.

CMS Manual System – CMS.gov

www.cms.gov

Apr 5, 2013 … The Description Field on the UB-04 is 24 characters in length. An example of the
… Grouper software program identified by CMS for national PPS as described in
the Federal Register for that year. … result in a special payment situation AI (see
below). …. FL71 – Prospective Payment System (PPS) Code.

CMS Manual System – CMS.gov

www.cms.gov

Dec 31, 2015 … located on the UB-04, or 837I transaction appearing on the claim form, the
Centers for Medicare and … The Patient's Reason (FL 70a-c) is a “Situational”
reported field. ….. FL71 – Prospective Payment System (PPS) Code.

CMS Manual System – CMS.gov

www.cms.gov

Oct 5, 2009 … B. Policy: Field Locator 17 of the UB-04 and its electronic equivalence is a
required field on all …. Usage Note: Cancer hospitals excluded from Medicare
PPS and … 71-99 Reserved for national assignment … Situational.

CMS Manual System – CMS.gov

www.cms.gov

Jan 5, 2009 … Processing the UB-04 (CMS-1450) Data Set” for further information …. Medicare
PPS assessments if SNF staff believe the sanction was in error and may be …
Situational. … Codes, complete field 31a – 34a (line level) before the “b” fields. …..
which is covered on the cost report. 71. Hospital Prior Stay Dates.

471-000-71 appendix – Nebraska Department of Health and Human …

dhhs.ne.gov

These instructions can be used in combination with the CMS-1450 (UB-04) … the
National Uniform Billing Committee Data Specifications Manual's CMS-1450 …
Situational …. 71. Prospective Payment System (PPS) Code. Not Used. 72. ICD-9
External … NOTE: For Assisted Living providers, effective 01/01/2012 this field is.

Quick Reference: Temporary Instructions for Submitting … – CMS.gov

www.cms.gov

Mar 13, 2013 … billing purposes, but only SPN65 needs to be present in the field: REF*G1*
SPN65~ …. UB-04 CMS-1450. APPROVED … 71 PPS CODE. 72 ECI.