CMS 1450 - Field 4 - 3 digit number how to form ?

UB 04 FL 4. Type of Bill

a. Must not be spaces.
b. Must be a valid code for billing. Valid codes are:

First Digit - Type of Facility:
1 - Hospital
NOTE: Hospital-based multi-unit complexes may also have use for the following first digits when billing non-hospital services:
2 - Skilled Nursing
3 - Home Health
4 - Religious Non-Medical (Hospital)
7 - Clinic or Renal Dialysis Facility (requires special information in second digit below)
8 - Special Facility or Hospital ASC Surgery (requires special information in second digit, see below)


Second Digit - Classification (if first digit is 1-5):
1 - Inpatient (Part A)
2 - Hospital-Based or Inpatient (Part B) (includes HHA visits under a Part B plan of treatment)
3 - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment)
4 - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, hospital and SNF for diagnostic clinical laboratory services for “nonpatients”)
8 - Swing bed (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement)

Second Digit - Classification (first digit is 7):
1 - Rural Health Clinic (RHC)
2 - Hospital-Based or Independent Renal Dialysis Facility
4 - Other Rehabilitation Facility (ORF)
5 - Comprehensive Outpatient Rehabilitation Facility (CORF)
6 - Community Mental Health Center (CMHC)
7 - Free-Standing Provider-Based Federally Qualified Health Center (FQHC)

Second Digit - Classification (first digit is 8):
1 - Hospice (Nonhospital-based)
2 - Hospice (Hospital-based)
5 - Critical Access Hospital (CAH)


Third Digit - Frequency:
A - Admission/Election Notice
B - Hospice/Medicare Coordinated Care Demonstration/Religious Non-Medical Health Care Institution-Termination/Revocation Notice
C - Hospice Change of Provider
D - Hospice/Medicare Coordinated Care Demonstration/Religious Non-Medical Health Care Institution-Void/Cancel
E - Hospice Change of Ownership
F - Beneficiary Initiated Adjustment Claim (For A/B MAC (A) use only)
G - CWF Initiated Adjustment Claim (For A/B MAC (A) use only)
H - CMS initiated Adjustment Claim (For A/B MAC (A) use only)
I - A/B MAC (A) Adjustment Claim (Other than QIO or Provider) (For A/B MAC (A) use only)
J - Initiated Adjustment Claim-Other (For A/B MAC (A) use only)
K - OIG Initiated Adjustment Claim (For A/B MAC (A) use only)
M - MSP Initiated Adjustment Claim (For A/B MAC (A) use only)
P - QIO Adjustment Claim (For A/B MAC (A) use only)
Q – Claim Submitted for Reconsideration Outside of Timely Limits (For A/B MAC (A) use only)
0 - Nonpayment/zero claims
1 - Admit Through Discharge Claim
2 - Interim - First Claim
3 - Interim – Continuing Claims (Not valid for PPS bills. Exception: SNF PPS bills)
4 - Interim – Last Claim (Not valid for PPS bills. Exception: SNF PPS bills)
5 - Late charge
7 - Correction
8 - Void/Cancel
9 - Final Claim for a Home Health PPS Episode