tci Outpatient Facility Coding Alert - 2014 Issue 4

Reader Question: Know When to Use UB04 vs. CMS-1500 Form

Question: Under which circumstance can a freestanding ASC use both the UB-04 and CMS-1500 claim forms for the same patient? Pennsylvania Subscriber Answer: Freestanding ASCs typically report services globally on the CMS-1500.  However, you may need to use both forms, depending upon payer requirements. Hospital-based ASCs generally use the UB-04 form for facility charges and the CMS-1500 form for the professional charges of the physician, but again check payer guidance. The definitions of the UB-04 and CMS-1500 are as follows: CMS -1500: The Form CMS-1500 is the standard paper claim form used by health care professionals and suppliers...

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