UB04 Admission Source Code 1: Non-Healthcare Facility Point of Origin (Physician Referral)

Overview

Admission Source Code 1, “Non-Health Care Facility Point of Origin (Physician Referral),” identifies patients who are referred to a hospital by a physician but do not originate from another health care setting. According to Noridian, this code includes patients coming from home, a physician’s office, or the workplace. For inpatient stays, the patient is admitted upon order of a physician; for outpatient services, the patient presents with a physician order for services. ^[1] The code is distinct from transfers from other facilities (codes 4–6, D, E, F) and from court/law enforcement admissions (code 8). MassHealth requires acute inpatient and outpatient hospitals, including hospital‑licensed health centers, to use the UB‑04 claim form when submitting paper claims. ^[2] Providers must enter the correct point‑of‑origin code in the designated field to accurately reflect the patient’s source of admission and to ensure proper claim processing.

When to Use

Use Code 1 when the patient is referred for hospital services by a physician and the patient’s location immediately before admission is not a health care facility. Typical scenarios include a patient at home who is directed to the emergency department for an inpatient admission, a patient seen in a physician’s private office who is then referred to the hospital for outpatient testing, or a patient at a workplace who is sent to the hospital by a physician. ^[1] Distinguish this code from Code 2 (“Clinic or Physician’s Office”), which applies when the patient is already present at a clinic or physician’s office and is admitted directly from that location as an inpatient or presents for outpatient services. Code 1 should not be used for any transfer from another healthcare facility, such as a skilled nursing facility (Code 5), a hospital (Code 4), or an ambulatory surgery center (Code E). Proper selection ensures that the claim accurately represents the patient’s origin, which can affect reimbursement and quality measurement.

Step‑by‑Step Claim Example

A Medicare patient is seen at her home by her primary care physician, who determines she requires an inpatient hospital stay. The physician writes a formal admission order and the patient presents to the hospital admissions office. The hospital’s billing staff prepares a UB‑04 claim for the acute inpatient admission. Based on the Noridian definition, the point‑of‑origin code is 1 because the patient came from her home (a non‑healthcare setting) and was admitted upon physician order. ^[1] The coder enters Code 1 in the point‑of‑origin field on the UB‑04 form. The type of admission (e.g., elective or urgent) and principal diagnosis are completed according to standard guidelines. MassHealth requires this claim to be submitted electronically unless a waiver has been granted; if a paper waiver is in place, the UB‑04 is mailed to the appropriate address. ^[2] The claim is then processed with the correct point‑of‑origin code, helping the payer recognize that the admission originated from a non‑healthcare setting via a physician referral.

Common Mistakes & Audit Red Flags

A frequent error is confusing Code 1 with Code 2 (“Clinic or Physician’s Office”). Code 1 applies when the patient comes from home or workplace and the physician referral initiates the hospital encounter. Code 2 applies when the patient is already at a clinic or physician’s office and is admitted or treated from that location. ^[1] Using Code 1 for a patient transferred from a skilled nursing facility (Code 5) or from another hospital (Code 4) is another red flag, as these require distinct transfer codes. Another mistake occurs when the point of origin is unknown; in such cases Code 9 (“Information Not Available”) should be used instead of assuming Code 1. Auditors look for consistency between the point‑of‑origin code and the documentation in the medical record. If the record shows a transfer note or ambulance pickup from a nursing home, Code 1 would be incorrect. Ensuring accurate coding prevents claim denials and potential overpayments. The MassHealth guide stresses that all claims must be submitted with complete and accurate data. ^[2]

Related Codes/Fields

The table below lists the most common point‑of‑origin codes that may be used in the same field as Code 1, along with their meanings as defined by Noridian.

Code	Meaning (Short)	Description (per Noridian)
1	Non‑Health Care Facility Point of Origin (Physician Referral)	Patient from home, physician’s office, or workplace; admitted/presented upon physician order.
2	Clinic or Physician’s Office	Patient admitted or presented from a clinic or physician’s office.
4	Transfer from a Hospital (different facility)	Inpatient: acute care transfer; Outpatient: referred by physician of different facility.
5	Transfer from SNF, ICF, ALF, or NR	Resident of skilled nursing, intermediate care, assisted living, or nursing facility.
6	Transfer from another Health Care Facility	Other facility not defined elsewhere.
8	Court/Law Enforcement	Admission or referral upon direction of court or law enforcement.
9	Information Not Available	Reason for admission or patient origin unknown.
D	Transfer from one distinct unit of same hospital	Separate claim; inpatient or outpatient within same hospital.
E	Transfer from Ambulatory Surgery Center (ASC)	Patient came from an ASC.
F	Transfer from Hospice Facility	Patient came from a hospice facility.

^[1] These codes are entered in the point‑of‑origin field of the UB‑04 claim form, and each is mutually exclusive for a given claim.

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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