UB-04
The UB-04 is the standard claim form for institutional services — hospitals and facilities — and the counterpart to the professional CMS-1500.
Updated
The UB-04, also called the CMS-1450, is the standard claim form used to bill institutional services: hospital, facility, and other institutional care. It is maintained by the National Uniform Billing Committee (NUBC), and it is the counterpart to the CMS-1500 used for professional services.
Like the CMS-1500, it is normally transmitted electronically rather than filed on paper — as an 837I. It carries data a professional claim does not, because an institutional bill describes a stay or an episode rather than a set of individual professional services.
In practice
The professional/institutional split is the reason one encounter can produce two claims. A procedure performed in a hospital can generate an institutional claim for the facility's part and a professional claim for the physician's — billed on different forms, to different rules, and denied for different reasons.
Commonly confused with
- CMS-1500: The CMS-1500 bills professional services; the UB-04 bills institutional ones. Different maintainers, different data, different rules.
- 837I: The 837I is the electronic transaction carrying institutional claim data; the UB-04 is the paper form for the same information.