Type of Bill Codes

October 11th, 2018 - Find-A-Code
Categories:   Medicare   Billing  
0 Votes - Sign in to vote or comment.

Type of bill codes identifies the type of bill being submitted to a payer. Type of bill codes are four-digit alphanumeric codes that specify different pieces of information on claim form UB-04 or form CMS-1450 and is reported in box 4 on line 1.

First Digit = Leading zero. Ignored by CMS
Second Digit = Type of facility
Third Digit = Type of care
Fourth Digit = Sequence of this bill in this episode of care. Referred to as a "frequency" code

Type of Bill (TOB) is not required when a Physicians office reports claim on a CMS-1500.  Below are three charts, for the second, third, and fourth digits of your Type of Bill code. 

The second digit in your billing code specifies the Facility Type you are billing for. This is for the location, or place of service, only. These are used by institutions whether it be a clinic, hospital, skilled nursing facility or an ASC. Use one of the following:

2nd Digit Description
1 Hospital
2 Skilled Nursing Facility
3 Home Health
4 Religious Nonmedical Hospital
5 Religious Nonmedical Extended Care (Discontinued)
6 Intermediate Care
7 Clinic or Hospital ESRD Facility
8 Special facility or Hospital (CAH or ASC)
9 Reserved for National Assignment

The third digit is more specific, and each digit has three possible meanings depending on the type of facility or institution. Use one of the following:

3rd Digit Description
1 Except Clinics & Special Facilities: Inpatient Part A
Clinics Only: Rural Health Center
Special Facilities Only: Hospice (non-hospital based)
2 Except Clinics & Special Facilities: Inpatient Part B
Clinics Only: Hospital or Independent Renal Dialysis Center
Special Facilities Only: Hospice (hospital based)
3 Except Clinics & Special Facilities: Outpatient
Clinics Only: Free-Standing Provider-Based FQHC
Special Facilities Only: ASC Services to Hospital Outpatient
4 Except Clinics & Special Facilities: Other (Part B)
Clinics Only: Other Rehabilitation Facility
Special Facilities Only: Free Standing Birthing Center
5 Except Clinics & Special Facilities: Intermediate Care - Level I
Clinics Only: Comprehensive Outpatient Rehabilitation Facility
Special Facilities Only: CAH
6 Except Clinics & Special Facilities: Intermediate Care - Level II
Clinics Only: Community Mental Health Center
Special Facilities Only: Residential Facility (not used for Medicare)
7 Except Clinics & Special Facilities: Subacute Inpatient Eight Swing Bed (Rev code 019x req)
Clinics Only: Reserved for National Assignment
Special Facilities Only: Reserved for National Assignment
8 Except Clinics & Special Facilities: N/A
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

The fourth digit specifies the frequency of billing. Use one of the following:

4th Digit Description
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
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 PPS Bills): Use when a bill for which utilization is chargeable for same confinement or course of treatment has 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 a late charge is for:

  • Services on the 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 Noticee 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 Form CMS-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

Reporting Corrected Claims: Do not write "Corrected Claim"  on the claim form.  If you need to submit a VOIDED or corrected claim use the following claim frequency code.  

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

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

CMS and HHS Tighten Enrollment Rules and Increase Penalties
October 1st, 2019 - Wyn Staheli, Director of Research
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
E-Health is a Big Deal in 2020
September 16th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...
Chiropractic 2020 Codes Changes Are Here
September 9th, 2019 - Wyn Staheli, Director of Research
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
Q/A: Is the Functional Rating Index by Evidence-Based Chiropractic Valid?
September 9th, 2019 - Wyn Staheli, Director of Research
Question Is the Functional Rating Index, from the Institute of Evidence-Based Chiropractic, valid and acceptable? Or do we have to use Oswestry and NDI? Answer You can use any outcome assessment questionnaire that has been normalized and vetted for the target population and can be scored so you can compare the results from ...
List of Cranial Nerves
September 3rd, 2019 - Find-A-Code
Cranial nerves are involved with some of our senses such as vision, hearing and taste, others control certain muscles in the head and neck. There are twelve pairs of cranial nerves that lead from the brain to the head, neck and trunk. Below is a list of Cranial Nerves and ...
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
August 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association