UB04 Admission Source Code 5: Transfer from a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), or Assisted Living Facility (ALF)

Overview

Admission Source Code 5 indicates that the patient was transferred from a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), Assisted Living Facility (ALF), or Nursing Facility (NF). For inpatient admissions, this code is used when the patient is admitted as a transfer from one of these facilities where they were a resident. For outpatient services, it is used when the patient is referred for outpatient services by a physician associated with the SNF, ICF, ALF, or NF. This code clarifies that the source of the patient is a long‑term or intermediate care setting, distinguishing it from a direct hospital transfer (Code 4) or a referral from a clinic or physician’s office (Code 2). ^[1]

When to Use

Code 5 should be entered in Field 15 of the UB-04 claim form when the patient is coming from a Skilled Nursing Facility, Intermediate Care Facility, Assisted Living Facility, or a Nursing Facility. For inpatient claims, use this code if the patient was admitted directly from one of these facilities after having been a resident there. For outpatient claims, use the code when the patient presents for outpatient services and the order or referral originates from a physician affiliated with one of these facilities. Do not use Code 5 for transfers from a hospital (use Code 4), from an ambulatory surgery center (Code E), or from a hospice facility (Code F). Documentation in the medical record must clearly indicate the transferring facility type and the patient’s status as a resident. ^[1]

Step‑by‑Step Claim Example

Consider a patient who has been a resident at a skilled nursing facility (SNF) for two weeks and requires acute care for a urinary tract infection. The SNF physician transfers the patient to the local hospital. Upon admission, the hospital’s admitting staff records the patient’s source as “Transfer from SNF.” On the UB-04 claim form, Field 15 (Admission Source) must be filled with Code 5. The corresponding value is “Transfer from a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), or Assisted Living Facility (ALF).” The same code applies if the patient later returns to the hospital for an outpatient procedure ordered by the SNF physician. Always ensure that the patient’s medical record includes the transfer note from the SNF and the referring physician’s orders to support use of Code 5. ^[1]. For general guidance on completing the UB-04 form, refer to the MassHealth UB-04 Billing Guide. ^[2]

Common Mistakes & Audit Red Flags

A frequent error is using Code 5 when the patient was actually transferred from an acute care hospital, which requires Code 4 instead. Another mistake is using Code 5 for a patient who comes from home but was previously a resident of a SNF – the admission source must reflect the immediate point of origin, not the patient’s history. Auditors also flag claims when the documentation (e.g., transfer summary, physician order) does not specify that the patient was a resident of the transferring facility at the time of transfer. Additionally, using Code 5 for outpatient services when the physician referral comes from a hospital rather than from a SNF/ICF/ALF can lead to denials. Carefully match the code to the facility type defined in the source: Skilled Nursing, Intermediate Care, Assisted Living, or Nursing Facility. ^[1] (see definitions for codes 1, 4, 5, 6, etc.)

Related Codes/Fields

The table below lists other admission source codes commonly used in Field 15 of the UB-04, as defined by Noridian. Each code has a distinct meaning and should be selected based on the patient’s immediate point of origin.

Code	Meaning	Source
1	Non-Health Care Facility Point of Origin (Physician Referral) – home, physician’s office, or workplace	[1]
2	Clinic or Physician’s Office	[1]
4	Transfer from a Hospital (different facility)	[1]
5	Transfer from SNF, ICF, ALF, or NF	[1]
6	Transfer from Another Health Care Facility (not elsewhere defined)	[1]
8	Court/Law Enforcement – includes incarceration facilities	[1]
9	Information Not Available	[1]
D	Transfer from One Distinct Unit of Hospital to Another Distinct Unit of Same Hospital	[1]
E	Transfer from Ambulatory Surgery Center (ASC)	[1]
F	Transfer from Hospice Facility	[1]

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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