Complete Guide to UB-04 Patient Discharge Status Codes (2025): List & Meanings to Avoid Claim Denials

Discharge status codes, also known as patient status codes or discharge disposition codes, are crucial two-digit identifiers on institutional claims, particularly the UB-04 form. For 2025, understanding these codes is essential for accurate reimbursement and avoiding claim denials, especially with payers like Medicare, Medicaid, and commercial insurers maintaining high scrutiny. They indicate a patient’s disposition at discharge, directly impacting payment accuracy and compliance. This complete guide provides a comprehensive list and meanings for UB-04 patient discharge status codes, addressing common mistakes and specific payer policies.

What Are Discharge Status Codes? (Patient Status & Discharge Disposition Codes)

Discharge status codes—also frequently referred to as patient status codes or discharge disposition codes—are two-digit numeric identifiers that specify a patient’s destination or status at the time of discharge from an inpatient facility. These critical codes are entered in Field Locator 17 (FL17), also commonly known as Box 17, of the UB-04 claim form. While often used interchangeably, “discharge status codes” and “patient status codes” both refer to the same set of standardized codes used to communicate patient disposition to payers.

Defined by the National Uniform Billing Committee (NUBC), these codes are fundamental for hospitals, skilled nursing facilities (SNFs), and other institutional providers to ensure proper billing and compliance. Misuse can lead to significant claim processing issues, including denials and payment adjustments.

Quick Reference: Common UB-04 Discharge Status Codes & Meanings

Here’s a comprehensive list of commonly used discharge status codes, their definitions, and typical usage scenarios:

Why Accurate Patient Status Codes & Discharge Disposition Coding Matters

Getting the discharge status code right is more than just compliance—it directly impacts revenue and ensures appropriate medical billing. Here’s why these patient status codes are critical:

• Payment Accuracy & Medicare IPPS Transfer Policy: Medicare’s Inpatient Prospective Payment System (IPPS) significantly adjusts Diagnosis-Related Group (DRG) payments based on the patient’s discharge status. Incorrect discharge disposition codes can lead to reduced per diem payments for the transferring hospital, particularly for early discharges or transfers to certain post-acute care settings. An error could cause underpayments or costly recoupments.
• Downstream Claim Impact: If your discharge status code doesn’t align with the receiving facility’s claim or expected data, their payment could be delayed or denied. This highlights the importance of accurate communication and coding across the healthcare continuum.
• Audit Risk: Both government contractors and private payers frequently audit discharge status codes. Mistakes—even those not directly causing payment errors—can trigger extensive reviews, leading to administrative burdens and potential penalties.

2025 Updates: CMS Patient Discharge Status Codes, Medicare Policies & Payer Focus

While no new discharge codes were introduced for 2025, payer scrutiny on accurate patient discharge status codes remains exceptionally high. Both CMS (Centers for Medicare & Medicaid Services) and commercial insurers, such as UnitedHealthcare, continue to enforce strict alignment between the reported discharge status and the claim type and patient care plan.

CMS patient discharge status codes and related Medicare discharge policies are a particular area of focus. For instance, code 30 (still a patient) should only be used on interim claims for extended stays—never on final bills. Medicare’s IPPS transfer policy heavily relies on these codes to determine if a reduced per diem payment applies, especially when a patient is transferred from an acute care hospital to certain post-acute care settings before the geometric mean length of stay for their DRG. For example, a transfer to a Skilled Nursing Facility (Code 03) or an Inpatient Rehabilitation Facility (Code 62) within a specific timeframe can trigger a reduced payment for the transferring hospital. Staying informed about official CMS guidance on claim adjustments is crucial for compliance and maximizing appropriate reimbursement.

Detailed Breakdown of Key UB-04 Patient Status Codes

Understanding Discharge Status Code 01: Discharged to Home or Self-Care

Code 01 is among the most common discharge disposition codes, indicating that a patient has been discharged to their home, an apartment, a retirement home, or another type of self-care arrangement without requiring formal organized home health services or other institutional care. This code typically signifies that the patient has completed their course of treatment and is stable enough for independent living or care from family/friends. From a billing perspective, a discharge to home often results in the full DRG payment for inpatient hospital stays under Medicare’s IPPS, assuming all other criteria are met.

Discharge Status Code 03: Transferred to Skilled Nursing Facility (SNF)

When a patient requires ongoing skilled nursing care, they are typically discharged or transferred to a Skilled Nursing Facility (SNF), indicated by code 03. This transfer is a critical scenario for billing, particularly for acute care hospitals under Medicare’s IPPS. If the patient is transferred to a SNF before the average length of stay for their DRG, the transferring hospital’s DRG payment may be reduced to a per diem rate. This is part of the IPPS post-acute care transfer policy, designed to prevent duplicate payments across different care settings.

Discharge Status Code 06: Discharged/Transferred to Home Health Care

Code 06 signifies that a patient has been discharged from an inpatient facility and will receive organized home health services. This patient status code is essential because it signals the start of home health billing and can also impact the inpatient hospital’s reimbursement under IPPS, similar to transfers to SNFs or IRFs. Accurate use of code 06 ensures proper coordination of care and prevents payment discrepancies between the acute care provider and the home health agency.

When to Use Patient Status Code 20: Patient Expired

Discharge Status Code 20 is used when the patient expires during the inpatient stay. When reporting this code, it is mandatory to also provide the date of death in the appropriate field on the UB-04 form. For Medicare, this code generally results in the full DRG payment to the hospital, as the patient’s death is typically considered the completion of the acute care episode, irrespective of the length of stay.

Discharge Status Code 30 for Interim Billing: Still a Patient

Patient Status Code 30 indicates that the patient is “still a patient” and is used exclusively for interim billing. This code is critical for billing extended inpatient stays that span multiple calendar months or billing cycles, allowing facilities to receive partial payments before the patient’s final discharge. It is a common mistake to use Code 30 on a final claim; doing so will result in claim denial. Final claims must always reflect the actual, definitive patient disposition.

Discharge Status Code 62: Discharged/Transferred to an Inpatient Rehabilitation Facility (IRF)

Code 62 denotes that a patient has been transferred to an Inpatient Rehabilitation Facility (IRF) for intensive rehabilitative services. Similar to transfers to SNFs, transfers to IRFs can trigger Medicare’s IPPS transfer policy, potentially reducing the transferring hospital’s DRG payment if the transfer occurs early in the inpatient stay. Precise documentation supporting the medical necessity for IRF admission is vital for both the transferring hospital and the IRF.

Discharge Status Code 71: Discharged/Transferred to Assisted Living (ALF) or Other Residential Non-Medicare Certified Facility

Code 71 is used when a patient is discharged or transferred to an Assisted Living Facility (ALF), a residential care home, or any other residential facility that is not Medicare-certified. This code is increasingly important as more patients transition to these settings for long-term support rather than medical care. It signifies that the patient no longer requires inpatient hospital services but still needs some level of supportive living arrangement.

Best Practices for Accurate UB-04 Discharge Status Coding

• Verify the Discharge: Always confirm the patient’s actual disposition—especially if discharge plans changed. This is the single most important step to ensure accurate patient status coding.
• Review Documentation Thoroughly: Ensure all clinical notes, discharge summaries, and case management records fully support the patient status code used. Inconsistent documentation is a primary cause of audit failures.
• Avoid Code 30 Errors: Reinforce training that Code 30 is only for interim bills. Never use “still a patient” as a default on final claims.
• Train Billing and Clinical Staff: Develop a comprehensive quick-reference guide with all common discharge disposition codes, their full definitions, typical usage scenarios, and payer-specific notes. Regular training can significantly reduce errors.
• Cross-Departmental Coordination: Foster strong communication between clinical, case management, and billing departments to ensure everyone is aligned on the patient’s final disposition.

Discharge Status Examples by Setting

Hospital Inpatient Billing Disposition Scenarios

• Discharge to SNF → Use 03
• Discharge to home health → Use 06
• Patient transferred to another acute care hospital → Use 02
• Planned readmission → Use 81–95 series codes (e.g., 81 – Discharged to hospital for readmission)

Skilled Nursing Facility (SNF) Billing Disposition Scenarios

• Resident still in facility at month-end → Use 30
• Resident discharged to acute care hospital → Use 02

Common Mistakes in Patient Discharge Status Coding and How to Avoid Them

• Mismatch between plan and reality: A common error occurs when the initial discharge plan changes, but the billing record isn’t updated. For example, a patient might be planned for a Skilled Nursing Facility (Code 03), but due to bed availability or a change in family wishes, they are ultimately discharged home (Code 01). The code submitted must always reflect the patient’s actual disposition, not just the initial plan. Always verify the patient’s final destination.
• Confusing similar codes: Some discharge disposition codes have nuanced differences that are frequently confused, leading to denials.
  • Example: Code 03 (SNF) vs. Code 62 (IRF): Both are post-acute care facilities, but they offer different levels of care and impact billing differently under Medicare’s IPPS transfer policy. An SNF provides skilled nursing and therapy, while an IRF requires intensive, multi-disciplinary rehabilitation. Rely on comprehensive documentation from discharge planners and clinical notes to distinguish between these facilities.
  • Example: Code 01 (Home) vs. Code 06 (Home Health): While both involve discharge to home, Code 06 specifically indicates the need for organized home health services. Omitting the “home health” designation when it’s provided can lead to payment discrepancies and audit findings.
• Misuse of Code 30 for final claims: As highlighted, Code 30 (“Still a Patient”) is strictly for interim billing. Submitting a final claim with Code 30 will result in automatic denial. Ensure your billing system and staff are trained to update the discharge status to the definitive final code before submitting the final bill.
• Missing death/hospice codes: Failing to use appropriate codes like 20 (Patient Expired), 40-42 (Hospice), or 50/51 (Hospice, specific to facility types) when applicable is a significant error. Always report the correct code and the date of death when required for Code 20.

Frequently Asked Questions About Patient Status Codes

Do professional claims (CMS-1500) require discharge disposition codes?

No. Patient status codes and discharge disposition codes are only required on institutional claims (UB-04), not professional claims filed with the CMS-1500 form.

Can the discharge code delay another provider’s payment?

Yes. If your reported discharge status code doesn’t match the receiving facility’s expected patient disposition data, their claim could be delayed, reviewed, or even denied. Effective coordination between facilities is crucial to avoid such issues.

Should I ever use patient status code 30 on a final claim?

Absolutely not. Code 30 (still a patient) is strictly for interim bills for extended stays. Final claims must always reflect the actual, definitive discharge status of the patient at the conclusion of their encounter.

Conclusion

Accurate UB-04 patient discharge status codes are foundational for compliant healthcare billing, directly impacting claim acceptance, reimbursement, and audit outcomes. In 2025, with continued payer scrutiny, it’s more critical than ever to ensure your team has a thorough understanding of each code’s definition, its implications for Medicare’s IPPS transfer policy, and best practices for documentation. By carefully reviewing patient disposition documentation, understanding code nuances, and implementing robust staff training, providers can avoid costly mistakes and ensure optimal revenue cycle management.

For more institutional billing help, explore our guides on UB-04 field usage and ICD-10 coding tips.