UB04 Field 15: Admission Source

Overview

Box 15 of the UB-04 claim form captures the Admission Source, also referred to as the patient’s point of origin. This field identifies where the patient was immediately prior to receiving inpatient or outpatient services. The source is reported using a single-character code. According to the Noridian Medicare guide, the code set includes entries for non‑health‑care facility points of origin (e.g., physician referral from home, workplace, or physician’s office – code 1), clinic or physician’s office (code 2), transfers from other facilities (codes 4, 5, 6, D, E, F), court/law enforcement (code 8), and information not available (code 9). ^[1] The MassHealth UB-04 billing guide affirms that the UB-04 claim form is used by acute inpatient and outpatient hospitals, but does not provide field‑specific code definitions; the detail above comes from the Noridian source. ^[2]

When to Use

Field 15 must be completed for both inpatient and outpatient claims whenever the information is available. The Noridian source provides distinct instructions for each setting. For inpatient admissions, the code reflects the origin of the patient at the time of admission (e.g., “admitted upon order of physician” for code 1, or “admitted as transfer from hospital inpatient within same hospital” for code D). For outpatient services, the code reflects where the patient presented from (e.g., “presents with physician order for services” for code 1, or “came for outpatient services from ASC” for code E). ^[1] Code 9 is used when the admission source is unknown, as defined by Noridian. However, payers expect a definitive code whenever possible. The MassHealth guide does not provide field-specific instructions for Box 15. ^[2]

Step-by-Step Claim Example

Consider a patient admitted to an acute hospital for inpatient care after a visit to her primary care physician’s office.

1. Identify the patient’s location prior to admission: The patient was at her physician’s office, which is a clinic or physician’s office.
2. Select the correct code: According to Noridian, code 2 means “Clinic or Physician’s Office.” For inpatient: “admitted to this facility.” For outpatient (if later referred): “presented for outpatient services.” ^[1]
3. Enter the code in Box 15: On the UB-04 form, enter “2” in the field labeled “Admission Source.”
4. Verify with supporting documentation: The physician’s referral order and clinic notes confirm the origin.
5. Submit the claim: The completed UB-04 includes Box 15 with code 2, along with all other required fields.

If the same patient was instead transferred directly from the inpatient unit of another acute hospital, the correct code would be “4” (Transfer from a Hospital – different facility). ^[1] Always cross‑check the code definition against the clinical record before submission.

Common Mistakes & Audit Red Flags

Several errors in Box 15 frequently trigger audit scrutiny or claim denial. Code 9 should only be used when the source is not known. The Noridian source explicitly states that code 9 should only be used when “reason for admission not known” (inpatient) or “where patient came from unknown” (outpatient). ^[1] Ensure correct code selection: Noridian defines code D for transfers within the same hospital distinct units, and code 4 for transfers from a different facility. Code D is defined as “Transfer from One Distinct Unit of Hospital to Another Distinct Unit of Same Hospital.” ^[1] Mixing inpatient and outpatient logic: A code used correctly for inpatient may be wrong for an outpatient claim (e.g., code 1 means “admitted upon order of physician” for inpatient but “presents with physician order” for outpatient; a facility might incorrectly default to code 1 for all outpatient visits regardless of actual origin). Omission of field when the source is known can cause administrative denials. The MassHealth guide does not list field‑specific errors, but generally incomplete fields delay processing. ^[2] Auditors will compare the point of origin to the referral documentation and prior claim history; discrepancies raise red flags.

Related Codes/Fields

The following table lists the point‑of‑origin codes as defined by Noridian, along with their application for inpatient and outpatient claims. ^[1]

Code	Description	Inpatient Use	Outpatient Use
1	Non‑Health Care Facility Point of Origin (Physician Referral)	Admitted upon order of physician from home, physician’s office, or workplace	Presents with physician order for services
2	Clinic or Physician’s Office	Admitted to this facility	Presented for outpatient services
4	Transfer from a Hospital (different facility)	Admitted as hospital transfer from acute care facility	Referred for outpatient services by physician of different facility
5	Transfer from a SNF, ICF, ALF, or NR	Admitted as transfer from Skilled Nursing Facility, Intermediate Care Facility, Assisted Living Facility, or Nursing Facility	Referred by physician of SNF/ICF/ALF/NF
6	Transfer from another Health Care Facility	Admitted as transfer from other health care facility not defined elsewhere	Referred by physician of other health care facility
8	Court/Law Enforcement	Admitted upon direction of court or law enforcement	Referred upon direction of court or law enforcement
9	Information Not Available	Reason for admission not known	Where patient came from unknown
D	Transfer from One Distinct Unit of Hospital to Another Distinct Unit of Same Hospital	Admitted as transfer from hospital inpatient within same hospital	Received outpatient services as transfer from within same hospital
E	Transfer from Ambulatory Surgery Center (ASC)	Admitted as transfer from ASC	Came for outpatient services from ASC
F	Transfer from Hospice Facility	Admitted as transfer from hospice	Came for outpatient services from hospice

Box 15 interacts with other UB-04 fields such as Box 14 (Type of Admission) and Box 17 (Patient Discharge Status), though those fields are not detailed in the provided sources. Payment logic often uses the admission source to validate the type of admission; for example, a code 4 (transfer) should align with an admission type of “1” (emergency) or “2” (urgent) depending on the clinical situation. Providers should reference their payer’s billing manual for full field crosswalks.

---

References

[1] Noridian Point of Origin — https://med.noridianmedicare.com/web/jea/topics/claim-submission/point-of-origin-codes

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