UB04 Patient Sex Code M: Male

Introduction

Patient Sex Code M is used to identify the patient as Male on institutional claims. This code is reported in Field 11: Patient Sex.

Usage

This code is used across all facility types, including acute care hospitals and skilled nursing facilities, to document the biological sex of the patient at the time of admission. It is a required demographic element used by payers to validate that the services or procedures billed are clinically appropriate for a male patient.

Billing Impact

Accurate reporting is essential for claim adjudication, as a mismatch between the sex code and gender-specific procedure codes (such as prostate screenings) will result in immediate claim rejection or denial.