Type of Bill Code Structure (2018-08-30)

March 20th, 2019 - Find-A-Code
Categories:   Audits/Auditing   Billing  
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The UB-04 claim form (also known as CMS 1450) is the standard facility and residential claim form used to report health claims. The Type of Bill is reported in Block No. 4 of the UB04 claim form.

Type of bill codes are four-digit codes that describe the type of bill a provider is submitting to a payer. The codes are published in the National Uniform Billing Committee (NUBC) guidelines.

Each digit of the code has a specific purpose to identify the Type of Bill (TOB) submitted to the payer and is reported depending on the type of the facility such as Hospitals, Skilled nursing, Home health agencies, Clinic (Rural Health Clinic [RHC], Federally Qualified Health Center [FQHC], and Renal Dialysis Center [RDC]) or a Special facility.

Type of Bill Code Structure

This four-digit alphanumeric code provides three specific pieces of information after a leading zero. CMS ignores the leading zero. This three-digit alphanumeric code gives three specific pieces of information.

Type of Facility

CMS processes this as first digit

Second DigitDescription
1 Hospital
2 Skilled Nursing Facility (SNF)
3 Home Health
4 Religious Nonmedical (Hospital)
5 Religious Nonmedical (Extended Care) discontinued 10/1/05
6 Intermediate Care
7 Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit)
8 Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit)
9 Reserved for National Assignment

Type of Care

CMS processes this as second digit    

Third DigitDescription
1
  • Except Clinics & Special Facilities - Inpatient (Part A)
  • Clinics Only - Rural Health Center (RHC)
  • Special Facilities Only - Hospice (non-hospital based)
2
  • Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment)
  • Clinics Only - Hospital based or Independent Renal Dialysis Center
  • Special Facilities Only - Hospice (hospital based)
3
  • Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment)
  • Clinics Only - Free-Standing Provider-Based Federally Qualified Health Center (FQHC)
  • Special Facilities Only - ASC Services to Hospital Outpatients
4
  • Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services)
  • Clinics Only - Other Rehabilitation Facility (ORF)
  • Special Facilities Only - Free Standing Birthing Center
5
  • Except Clinics & Special Facilities - Intermediate Care - Level I
  • Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Special Facilities Only - CAH
6
  • Except Clinics & Special Facilities - Intermediate Care - Level II
  • Clinics Only - Community Mental Health Center (CMHC)
  • Special Facilities Only - Residential Facility (not used for Medicare)
7
  • Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.)
  • Clinics Only - Reserved for National Assignment
  • Special Facilities Only - Reserved for National Assignment
8
  • Except Clinics & Special Facilities - NA
  • Clinics Only - Reserved for National Assignment
  • Special Facilities Only - Reserved for National Assignment
9
  • Except Clinics & Special Facilities - Reserved for National Assignment
  • Clinics Only - Other
  • Special Facilities Only - Other

Frequency 

CMS processes this as third digit

Fourth DigitDescription
0 Non-payment/Zero Claim - Use when it does not anticipate payment from payer for the bill, but is informing the payer about a period of non- payable confinement or termination of care. "Through" date of this bill (FL 6) is discharge date for this confinement, or termination of plan of care
1 Admit Through Discharge - Use for a bill encompassing an entire inpatient confinement or course of outpatient treatment for which it expects payment from payer or which will update deductible for inpatient or Part B claims when Medicare is secondary to an Employer Group Health Plan (EGHP)
2 Interim - First Claim - Use for first of an expected series of bills for which utilization is chargeable or which will update inpatient deductible for same confinement of course of treatment. For HHAs, used for submission of original or replacement RAPs
3 Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) - Use when a bill for which utilization is chargeable for same confinement or course of treatment had already been submitted and further bills are expected to be submitted later
4 Interim - Last Claim (Not valid for PPS Bills) - Use for a bill for which utilization is chargeable, and which is last of a series for this confinement or course of treatment
5 Late Charge Only - These bills contain only additional charges; however, if late charge is for:
  • Services on same day as outpatient surgery subject to ASC limit; Services on same day as services subject to Outpatient PPS (OPPS);
  • ESRD services paid under composite rate;
  • Inpatient accommodation charges;
  • Services paid under HH PPS; and
  • Inpatient hospital or SNF PPS ancillaries.
It must be submitted as an adjustment request (xx7).
7 Replacement of Prior Claim (See adjustment third digit) - Use to correct a previously submitted bill. Provider applies this code to corrected or "new" bill
8 Void/Cancel of Prior Claim (See adjustment third digit) - Use to indicate this bill is an exact duplicate of an incorrect bill previously submitted. A code "7" (Replacement of Prior Claim) is being submitted showing corrected information
9 Final claim for a Home Health PPS Episode
A Admission/Election Notice for Hospice - Use when hospice or Religious Non-medical Health Care Institution is submitting Form CMS-1450 as an Admission Notice
B Hospice Termination/ Revocation Notice - Use when Form CMS-1450 is used as a notice of termination/revocation for a previously posted Hospice/Medicare Coordinated Care Demonstration/Religious Non-medical Health Care Institution election
C Hospice Change of Provider Notice - Use when CMS Form-1450 is being used as a Notice of Change to Hospice provider
D Hospice Election Void/Cancel - Use when Form CMS-1450 is used as a Notice of a Void/Cancel of Hospice/Medicare Coordinated Care Demonstration/Religious Non-medical Health Care Institution election
E Hospice Change of Ownership - Use when Form CMS-1450 is used as a Notice of Change in Ownership for hospice
F Beneficiary Initiated Adjustment Claim - Use to identify adjustments initiated by beneficiary. For FI use only
G CWF Initiated Adjustment Claim - Use to identify adjustments initiated by CWF. For FI use only
H CMS Initiated Adjustment Claim - Use to identify adjustments initiated by CMS. For FI use only
I FI Adjustment Claim (Other than QIO or Provider) - Use to identify adjustments initiated by FI. For FI use only
J Initiated Adjustment Claim/Other - Use to identify adjustments initiated by other entities. For FI use only
K OIG Initiated Adjustment Claim - Use to identify adjustments initiated by OIG. For FI use only
M MSP Initiated Adjustment Claim - Use to identify adjustments initiated by MSP. For FI use only. Note: MSP takes precedence for other adjustment sources
P QIO Adjustment Claim - Use to identify adjustments initiated by QIO. For FI use only
Q Reopening/Adjustment - Use when the submission falls outside of period to submit an adjustment bill

Resource
Publication 100-04 

Last Updated Aug 30, 2018

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