UB04 Admission/Visit Type Code 3: Elective - The patient's condition permits adequate time to schedule the services.

Overview

Form Locator 14 (FL14) on the UB-04, labeled “Priority (Type) of Admission or Visit,” is a one-character alphanumeric field that indicates the urgency of the patient’s admission or visit. ^[1] (section 75.2) specifies that FL14 is a single-position field (size 1 AN) and that the codes used must come from the National Uniform Billing Committee (NUBC) approved list. Accurate reporting of this code is essential for proper claim processing, reimbursement, and utilization review.

When to Use

MassHealth further instructs providers to complete all fields accurately to avoid claim rejections or delays. ^[2] (page 4). Using code 3 for a patient who is truly urgent (code 2) or emergent (code 1) can lead to audit findings, payment denials, and potential fraud allegations. Therefore, only assign code 3 when the patient’s condition permits a delay of at least 24 hours without risk of deterioration. This code is also appropriate for observation visits that are scheduled in advance, as long as the patient’s condition is not acute.

Step-by-Step Claim Example

Consider a 68‑year‑old patient scheduled for a total knee replacement. The surgeon determines the patient is stable and the procedure can be planned weeks in advance. On the UB-04 claim form:

• FL12 (Admission/Start of Care Date): Enter the date of admission (e.g., 01/15/2025). ^[1] (section 75.2).
• FL13 (Admission Hour): Enter the hour of admission (e.g., 07 for 7:00 AM). ^[1] (section 75.2).
• FL14 (Priority of Admission): Enter the single character “3” to indicate elective admission. ^[1] (section 75.2) confirms this field is one character and must use NUBC codes.
• FL15 (Point of Origin): Enter the appropriate code (e.g., “1” for non‑healthcare facility point of origin). ^[1] (section 75.2).

The MassHealth guide notes that all fields must be legible and completed in black ink for paper submissions. ^[2] (page 1). After the claim is submitted, the payer will use the code 3 to verify that the admission was pre‑authorized (if required) and that the services are appropriate for an elective setting. The example claim would also include a Type of Bill (FL04) starting with “11” for inpatient or “13” for outpatient, and the appropriate revenue codes for the surgery.

Common Mistakes & Audit Red Flags

One frequent error is using code 3 for admissions that are actually urgent or emergent, often to bypass prior authorization requirements or to avoid higher copayments. Medicare and MassHealth auditors flag such mismatches because they can indicate upcoding or inappropriate billing. ^[1] (section 75) requires that all NUBC codes be used correctly; incorrect coding may result in claim denial or recoupment. Another mistake is leaving FL14 blank or entering an invalid character. The field is mandatory for all institutional claims, and a blank or “0” will cause the claim to be rejected. ^[2] (page 4) stresses that incomplete forms will be returned. Additionally, providers sometimes confuse code 3 with code 2 (Urgent) when the patient’s condition is stable but the procedure is scheduled within 24 hours. The NUBC definition, as referenced in CMS Chapter 25, clearly distinguishes elective (code 3) from urgent (code 2). Auditors also look at the correlation between FL14 and the patient’s discharge status (FL17) and length of stay; an elective admission that results in an unexpected death or transfer to a higher level of care may trigger a medical necessity review. To avoid red flags, always document the clinical rationale for the elective designation in the medical record.

Related Codes/Fields

The table below lists the other priority codes for FL14 as defined by the NUBC, along with related fields on the UB-04 that interact with the admission type.

Field / Code	Description	Source
FL14 Code 1	Emergency – The patient requires immediate medical intervention as a result of severe, life‑threatening, or potentially disabling conditions.	[1] (references NUBC)
FL14 Code 2	Urgent – The patient requires immediate attention for the care and treatment of a condition, but not to the degree of an emergency.	[1] (references NUBC)
FL14 Code 3	Elective – The patient’s condition permits adequate time to schedule the services.	[1] (references NUBC)
FL14 Code 4	Newborn – Admission of a newborn infant.	[1] (references NUBC)
FL14 Code 5	Trauma Center – Admission to a designated trauma center.	[1] (references NUBC)
FL14 Code 9	Information not available – Use when the priority is unknown at the time of billing.	[1] (references NUBC)
FL12	Admission/Start of Care Date – Must be consistent with the priority code; elective admissions typically have a scheduled date.	[1] (section 75.2)
FL13	Admission Hour – Should reflect the actual time of admission; elective admissions often occur during normal business hours.	[1] (section 75.2)
FL15	Point of Origin for Admission or Visit – Indicates the source of the patient (e.g., home, clinic, transfer).	[1] (section 75.2)

*Note: The complete list of NUBC codes for FL14 is maintained by the National Uniform Billing Committee. For additional codes (e.g., 6, 7, 8), refer to the current

---

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