Medicare Billing Codes

Medicare Billing Codes explained for Provider services Part B and Hospital insurance as reported on the UB-04 for Part A. Codes used for Medicare don’t really differ from the standard ICD and HCPCS/CPT codes used when submitting claims to commercial or Blue Cross carriers. I’m not involved as much with Part A inpatient hospital coverage for hospitals or clinics – but there are a lot of unique billing codes used for inpatient facilities.

Part B - CMS-1500

There are no unique coding requirements for provider services with Medicare. Part B Medicare for outpatient physician office visits uses the standard ICD-9 and HCPCS/CPT codes. I think of the codes used for Part B as those used for the typical CMS-1500 form for outpatient physician or health care provider visits.

Part A More Complicated

The medicare codes used for hospitals, clinics, or other inpatient facilities are much more involved than for your typical physician patient encounter. Part A coverage is submitted in the UB-04 format. The UB-04 is the insurance claim form used to bill for facility or institutional services such as hospitals and clinics. This form has 81 field locations compared to 33 for the CMS-1500. This is obviously much more complicated than the documentation for Part B patient encounters.

Lots of Unique Codes

There are numerous unique codes used for the UB-04 such as condition codes, occurrence codes, occurrence span codes, value codes, revenue codes, treatment authorization codes... An explanation of these are provided in great detail in chapter 25 of the 126 page Medicare Claims Processing Manual.

These medicare codes are in addition to the ICD diagnosis and HCPCS (CPT and or HCPCS level II) treatment codes also documented on the UB-04. Learning these codes for inpatient or Part A insurance is a specialty.

Needless to say correctly filling out the UB-04 and getting all the correct codes can be a bear. If you’re looking for simple instruction for completing the UB-04, I suggest Quick and Easy Guide to Filling Out The UB04 Forms Line by Line, and Box by Box! It’s a wise investment if you are struggling to correctly complete the UB-04 and get paid properly.

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