UB04 Admission Source Code 2: Clinic Referral

Overview

UB-04 Field 15 (Source of Admission) Code 2 indicates a Clinic Referral, meaning the patient was referred to the hospital or facility from a clinic or physician’s office. This code applies to both inpatient and outpatient settings. For inpatient admissions, the patient is admitted to the facility upon the order of a physician from a clinic or office. For outpatient services, the patient presents for services with a referral from a clinic or physician’s office. ^[1]

This code is distinct from Code 1 (Non-Health Care Facility Point of Origin/Physician Referral), which covers patients coming from home, workplace, or a physician’s office without a clinic intermediary. Code 2 specifically captures referrals originating from a clinic setting, which may include hospital-based clinics, community health centers, or private physician clinics. ^[1]

MassHealth requires accurate reporting of source of admission codes on UB-04 claims submitted by acute inpatient hospitals and acute outpatient hospitals, including hospital-licensed health centers. ^[2] Proper use of Code 2 ensures correct claim processing and reimbursement, as payers use this information to verify medical necessity and appropriate patient flow.

When to Use

Use Code 2 when a patient is referred to your facility from a clinic or physician’s office for either inpatient admission or outpatient services. This includes:

• Inpatient admissions: A patient is admitted to the hospital upon the order of a physician from a clinic or physician’s office. The clinic physician determines the need for hospitalization and arranges the admission. ^[1]

• Outpatient services: A patient presents for outpatient services (e.g., diagnostic tests, procedures, or treatments) with a referral from a clinic or physician’s office. The clinic physician orders the services but does not admit the patient. ^[1]

Do not use Code 2 for:

• Patients coming from home without a clinic referral (use Code 1)
• Transfers from other hospitals (use Code 4)
• Transfers from skilled nursing facilities (use Code 5)
• Court or law enforcement referrals (use Code 8)
• Transfers from ambulatory surgery centers (use Code E)
• Transfers from hospice facilities (use Code F) ^[1]

Step-by-Step Claim Example

Scenario: A 65-year-old patient visits their primary care physician’s clinic for chest pain. The physician orders an immediate hospital admission for cardiac evaluation. The patient is admitted to the hospital directly from the clinic.

Step 1: Complete the UB-04 claim form header with facility information, patient demographics, and payer details as per MassHealth instructions. ^[2]

Step 2: In Field 15 – Source of Admission, enter Code 2 (Clinic Referral). This indicates the patient was referred from a clinic or physician’s office for inpatient admission. ^[1]

Step 3: Complete Field 14 – Priority (Type) of Admission with the appropriate code (e.g., 1 for Emergency, 2 for Urgent, 3 for Elective).

Step 4: In Field 16 – Patient Discharge Status, enter the appropriate code (e.g., 01 for discharged to home, 02 for discharged to another facility).

Step 5: Complete all other required fields including patient demographics, diagnosis codes (ICD-10-CM), procedure codes (ICD-10-PCS or CPT/HCPCS), revenue codes, and charges.

Step 6: Submit the claim electronically or on paper if a waiver has been approved. MassHealth requires electronic submission unless a waiver is granted. ^[2]

Example claim data:

• Field 14: 2 (Urgent)
• Field 15: 2 (Clinic Referral)
• Field 16: 01 (Discharged to home)
• Diagnosis: I20.9 (Angina pectoris, unspecified)
• Revenue code: 0110 (Medical/Surgical ICU)
• Charges: $15,000

Common Mistakes & Audit Red Flags

Mistake 1: Using Code 2 when patient came from home without clinic referral. If the patient was at home and called 911 or came to the emergency department without a clinic referral, use Code 1 (Non-Health Care Facility Point of Origin). Using Code 2 incorrectly may trigger audits for medical necessity. ^[1]

Mistake 2: Confusing Code 2 with Code 1 for physician office referrals. Code 1 is for patients coming from a physician’s office directly (without a clinic intermediary). Code 2 is specifically for clinic referrals. If the referral originates from a clinic setting (e.g., hospital outpatient clinic, community health center), use Code 2. ^[1]

Mistake 3: Using Code 2 for transfers from other facilities. Transfers from hospitals (Code 4), skilled nursing facilities (Code 5), ambulatory surgery centers (Code E), or hospice facilities (Code F) have their own codes. Using Code 2 for these situations will result in claim denials. ^[1]

Audit Red Flag: Inconsistent use of Code 2 with other fields. For example, if Field 15 shows Code 2 but the patient’s medical record indicates they were transferred from another hospital, this discrepancy may trigger a payer audit. Ensure documentation supports the source of admission code.

Audit Red Flag: Using Code 2 for outpatient services when the patient was actually referred from a non-clinic setting. Payers may review medical records to verify the referral source.

Related Codes/Fields

Field	Code	Meaning	Notes
Field 15 – Source of Admission	1	Non-Health Care Facility Point of Origin (Physician Referral)	Patient from home, office, or workplace
Field 15 – Source of Admission	2	Clinic Referral	Patient referred from clinic or physician’s office
Field 15 – Source of Admission	4	Transfer from a Hospital (different facility)	Patient transferred from acute care hospital
Field 15 – Source of Admission	5	Transfer from SNF, ICF, ALF, or NR	Patient transferred from skilled nursing or similar facility
Field 15 – Source of Admission	6	Transfer from another Health Care Facility	Patient transferred from other facility not elsewhere defined
Field 15 – Source of Admission	8	Court/Law Enforcement	Patient admitted upon court or law enforcement direction
Field 15 – Source of Admission	9	Information Not Available	Source of admission unknown
Field 15 – Source of Admission	D	Transfer from One Distinct Unit of Hospital to Another	Same hospital, separate claim
Field 15 – Source of Admission	E	Transfer from Ambulatory Surgery Center (ASC)	Patient transferred from ASC
Field 15 – Source of Admission	F	Transfer from Hospice Facility	Patient transferred from hospice
Field 14 – Priority (Type) of Admission	1	Emergency	Patient requires immediate medical intervention
Field 14 – Priority (Type) of Admission	2	Urgent	Patient requires care within 24 hours
Field 14 – Priority (Type) of Admission	3	Elective	Patient scheduled for admission

All codes from ^[1] and ^[2]

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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