The UB-04, also designated CMS-1450, is the uniform institutional claim form used by hospitals, skilled nursing facilities, and other facilities. It captures patient data, admission and discharge information, revenue codes, procedure codes, and charges.
Physician services are billed separately on the CMS-1500.
Alternative Names:
UB-04, CMS-1450, Institutional Claim Form
Why it Matters?
The UB-04 carries information the itemized statement does not, including admission source, discharge status, and diagnosis-related grouping. Discharge status codes are particularly useful, since they indicate whether the patient went home, to another facility, or against medical advice, which bears on both damages and credibility. Revenue codes also identify the department providing each service.
Frequently Confused with
Related terms
Frequently asked questions
What information does the UB-04 carry?
Why is discharge status useful?
