Overview
The UB-04 claim form includes Field 14 (FL14) for the Priority (Type) of Admission or Visit. This field is defined in the CMS Chapter 25 layout as a 1‑character alphanumeric field. [1]
The MassHealth UB-04 Billing Guide references “Code Sets for the UB-04 Claim Form” but does not list individual code values in the provided excerpt. [2]
The provided sources do not contain a specific definition for code 4 (Newborn) or any instruction linking it to special newborn admission source codes in Field 15. Therefore, this article can only describe the field’s existence and general structure based on the available text.
When to Use
According to the CMS Chapter 25 layout, FL14 is used to indicate the priority or type of admission or visit. The field is required for all institutional claims. [1]
The MassHealth guide notes that providers must complete the UB-04 according to NUBC‑approved coding, but the specific circumstances for using code 4 are not described in the provided source material. [2]
Without explicit source documentation, this section cannot elaborate on when code 4 should be selected.
Step-by-Step Claim Example
Because the provided sources do not define code 4 or provide a claim example, a step‑by‑step example cannot be constructed from the available text. The CMS layout shows that FL14 is a single‑character field, and FL15 (Point of Origin for Admission or Visit) is also a single‑character field. [1]
The MassHealth guide states that code sets are used but does not list them. [2]
No further details are present to illustrate a newborn claim scenario.
Common Mistakes & Audit Red Flags
The sources do not mention common mistakes or audit red flags for code 4. The CMS layout indicates that FL14 and FL15 are separate fields, so a mismatch between the admission type and the point of origin could be a potential error, but this is not stated in the provided text. [1]
The MassHealth guide does not address audit flags. [2]
Therefore, no specific red flags can be cited from the given sources.
Related Codes/Fields
| Field | Description | Source |
|---|---|---|
| FL14 | Priority (Type) of Admission or Visit (1 AN) | [1] |
| FL15 | Point of Origin for Admission or Visit (1 AN) | [1] |
| Code Sets | Referenced but not listed in provided excerpt | [2] |
Note: The specific relationship between code 4 in FL14 and newborn admission source codes in FL15 is not documented in the provided sources.
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
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Last Updated: 2026-06-03
Sources: CMS Pub. 100-04 Chapter 25, NUBC Official UB-04 Manual, Medicare Contractor Bulletins (Noridian, Palmetto, CGS)