🧾 UB‑04 Field Reference

🎯 Purpose

Quick reference for key UB‑04 fields used in facility billing.


🧩 Key Fields

FieldDescription
FL 1Provider name/address
FL 4Type of bill
FL 12Admission date
FL 13Admission hour
FL 14Admission type
FL 15Admission source
FL 42-49Revenue codes
FL 44HCPCS/Rates
FL 66-69Diagnosis codes
FL 74Principal procedure
FL 76Attending provider

🧠 Notes

  • Type of bill drives billing logic
  • Revenue codes must match HCPCS
  • POA indicators required for IP claims