UB-04 Provider Type Identification & NPI Submission Guidelines
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UB 04 - Provider Type identifying field instruction,
55-56 Provider Type
This identifies providers that require special handling. Enter one of the following codes as appropriate.
00 or blanks = Short Term Facility 02 Long Term 03 Psychiatric 04 Rehabilitation Facility 05 Pediatric 06 Hospital Distinct Parts (Provider type “06” is effective until July 1, 2006. At that point, provider type “06” will no longer be used. Instead, contractors will assign a hospital distinct part as one of the following provider types: 49, 50, 51, 52, 53, or 54) 07 Rural Referral Center 08 Indian Health Service 13 Cancer Facility 14 Medicare Dependent Hospital (during cost reporting periods that began on or after April 1, 1990. 15 Medicare Dependent Hospital/Referral Center (during cost reporting periods that began on or after April 1, 1990. Invalid October 1, 1994 through September 30, 1997). 16 Re-based Sole Community Hospital 17 Re-based Sole Community Hospital /Referral Center 18 Medical Assistance Facility 21 Essential Access Community Hospital 22 Essential Access Community Hospital/Referral Center 23 Rural Primary Care Hospital 32 Nursing Home Case Mix Quality Demonstration Project - Phase II 33 Nursing Home Case Mix Quality Demonstration Project - Phase III - Step 1 34 Reserved 35 Hospice 36 Home Health Agency 37 Critical Access Hospital 38 Skilled Nursing Facility (SNF) - For non-demo PPS SNFs - effective for cost reporting periods beginning on or after July 1, 1998 40 Hospital Based ESRD Facility 41 Independent ESRD Facility 42 Federally Qualified Health Centers 43 Religious Non-Medical Health Care Institutions 44 Rural Health Clinics-Free Standing 45 Rural Health Clinics-Provider Based 46 Comprehensive Outpatient Rehab Facilities 47 Community Mental Health Centers 48 Outpatient Physical Therapy Services 49 Psychiatric Distinct Part 50 Rehabilitation Distinct Part 51 Short-Term Hospital - Swing Bed 52 Long-Term Care Hospital - Swing Bed 53 Rehabilitation Facility - Swing Bed 54 Critical Access Hospital - Swing Bed
FL 76. Attending Provider Name and Identifiers. a. The UPIN must be present on inpatient Part A bills with a “Through” date of January 1, 1992, or later. For outpatient and other Part B services, the UPIN must be present if the “From” date is January 1, 1992, or later. This requirement applies to all provider types and all Part B bill types. Effective May 23, 2007, providers are required to submit NPI.
b. An institutional provider may not submit their own NPI, except for Institutional billing of influenza and pneumococcal vaccinations and their administration as the only billed service on a claim, roster billing of influenza and pneumococcal vaccinations and their administrations, self-referred screening mammography as the only billed service on a claim, or where the provider only has a type-1 NPI as a physician/practitioner owned sole-proprietor.
FL 77. Operating Physician Name and Identifiers
a. Effective May 23, 2007, providers are required to submit NPI. NPI must be present if: • Bill type is 11X and a procedure code is shown in FL 74; • Bill type is 83X or 13X and a HCPCS code is reported that is subject to the ASC payment limitation or is on the list of codes the QIO furnishes that require approval; or • Bill type is 85X and HCPCS code is in the range of 10000 through 69979. b. If required: • NPI, last name and first initial must be present; and • Left justified.
FL 56. National Provider Identifier – Billing Provider a. Effective May 23, 2007, providers are required to submit their NPI. b. Left justified.