UB04 Admission/Visit Type Code 1: Emergency - The patient requires immediate medical intervention as a result of severe, life-threatening, or potentially disabling conditions.

Overview

Form Locator 14 (FL14) on the UB-04 claim form captures the Priority (Type) of Admission or Visit. This one-character alphanumeric field indicates the urgency or circumstance under which the patient was admitted or received services. ^[1] lists FL14 as a required data element for both inpatient and outpatient claims, with a field size of 1 and a buffer space of 2. The National Uniform Billing Committee (NUBC) maintains the approved code set for this field, and Medicare Administrative Contractors (A/B MACs) are responsible for capturing all NUBC-approved input data for audit trail purposes. ^[1] The MassHealth UB-04 Billing Guide confirms that providers must use the NUBC code sets when completing the UB-04 claim form, including FL14. ^[2] While the specific meaning of each code is defined by the NUBC, the field itself is critical for determining the appropriate payment methodology and for ensuring accurate claims processing.

When to Use

Providers should use code 1 only when the medical record clearly documents the emergency nature of the encounter; using it for scheduled or elective services would be incorrect.

Step-by-Step Claim Example

Consider a patient who arrives at the hospital emergency department via ambulance with acute respiratory distress. The provider determines that immediate life-saving intervention is required. On the UB-04 claim form, the following steps are taken for FL14:

1. Locate FL14 on the UB-04 form. According to the CMS layout, FL14 is located after FL13 (Admission Hour) and before FL15 (Point of Origin for Admission or Visit). ^[1]
2. Enter the code in the single-character field. For this emergency admission, the provider enters “1”.
3. Complete related fields that support the emergency designation:
   • FL12 (Admission/Start of Care Date): Enter the date of admission.
   • FL13 (Admission Hour): Enter the hour of admission (e.g., “14” for 2:00 PM).
   • FL15 (Point of Origin): Use code “1” for non‑healthcare facility point of origin (e.g., home) or “2” for clinic referral, as appropriate.
   • FL17 (Patient Discharge Status): Enter the appropriate discharge code after the patient is released.
4. Submit the claim electronically or, if an approved exception exists, on paper. The MassHealth guide notes that paper claims must follow the same completion instructions. ^[2]

The completed FL14 with code “1” signals to the payer that the admission was an emergency, which may affect reimbursement rates, coverage rules, and medical necessity review.

Common Mistakes & Audit Red Flags

• Using code 1 for non‑emergency services: If the medical record does not support an immediate, life‑threatening condition, using code 1 can trigger claim denials or audits. CMS requires that the priority code reflect the patient’s condition at admission. ^[1]
• Inconsistent coding with other fields: For example, if FL14 shows code 1 but FL15 (Point of Origin) indicates a routine transfer from a skilled nursing facility, the claim may be flagged for review. Payers expect logical consistency across all form locators.
• Missing or invalid code: FL14 is a required field; leaving it blank or entering a code not maintained by the NUBC will cause the claim to be rejected. The MassHealth guide stresses using only NUBC‑approved code sets. ^[2]
• Failure to update code after a change in patient status: If a patient initially admitted as an emergency is later determined to have a non‑urgent condition, the code should not be changed retroactively; the code is based on the condition at the time of admission.
• Audit red flags: Payers may audit claims with code 1 for high‑volume providers or for specific diagnosis codes that rarely require emergency admission. Providers should maintain clear documentation of the emergency nature in the medical record.

Related Codes/Fields

The following table lists fields on the UB-04 that are directly related to FL14 and are commonly used together to describe the admission or visit.

Field	Description	Source
FL12	Admission/Start of Care Date – the date the patient was admitted or care began.	[1]
FL13	Admission Hour – the hour of admission (00–23).	[1]
FL15	Point of Origin for Admission or Visit – indicates the source of the patient (e.g., home, clinic, transfer).	[1]
FL16	Discharge Hour – the hour of discharge (if applicable).	[1]
FL17	Patient Discharge Status – code indicating the patient’s disposition after discharge.	[1]
FL18–FL28	Condition Codes – additional codes that may describe special circumstances of the admission (e.g., emergency department visit).	[1]
FL31–FL36	Occurrence Codes and Dates – used to record specific events such as the date of the emergency.	[1]

These fields, when completed accurately together with FL14, provide a complete picture of the patient’s admission type and support correct claim adjudication.

---

References

[1] CMS Chapter 25 — https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c25.pdf

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download