It is used to bill Medicare, Medicaid, and other health insurance companies for inpatient or outpatient services.
This article explains who can fill out the form and what the form’s various sections mean.
Illustration by Julie Bang for Verywell Health
Who Can Bill Claims Using the UB-04?
Illustration by Julie Bang for Verywell Health
Any institutional provider can use the UB-04 for billingmedical claims.
Non-institutional providers or suppliers, such as physicians or providers of durable medical equipment, use the CMS-1500 form.
The UB-O4 form is used by institutions to bill insurance companies.
Fields of the UB-04
There are 81 fields or lines on a UB-04.
They’re referred to as form locators or “FL.”
Examples include hospitals, hospices, rural health clinics, and comprehensive outpatient rehabilitation facilities.
National Uniform Billing Committee.National Uniform Billing Committee Official Data Specifications Manual.
Centers for Medicare and Medicaid Services.Professional paper claim form (CMS-1500).
CMS.gov.Medicare Claims Processing Manual.
