UB04 Admission Source Code F: Transfer from a Hospice Facility

Overview

Code F in UB‑04 Field 15 (Point of Origin for Admission or Visit, also called Source of Admission) indicates a transfer from a hospice facility. This code is used for both inpatient and outpatient encounters when the patient arrives directly from a hospice setting. ^[1]

According to the Noridian point‑of‑origin guidance, for inpatient admissions the definition is “admitted as transfer from hospice.” For outpatient services it is “came for outpatient services from hospice.” This distinction ensures that the provider correctly identifies the patient’s origin, which can affect reimbursement, quality‑measure calculations, and medical‑necessity reviews. ^[1]

Field 15 is a two‑character alphanumeric field on the UB‑04 claim form. The code set includes letters A through F and numbers 1 through 9, each representing a distinct source or transfer type. ^[2] (general UB‑04 form instructions apply). Code F is specifically reserved for hospice transfers and is one of the “transfer” codes that trigger special billing rules, such as per‑diem payment adjustments or bundled payment logic. ^[1]

When to Use

Use code F when the patient was physically present in a hospice facility immediately before the current admission or outpatient encounter. This includes transfers from both inpatient hospice and hospice‑provided home care that is under a hospice facility’s management, provided the patient is officially transferred from that hospice. ^[1]

For inpatient admissions: the patient is admitted to the hospital as a transfer from a hospice facility. Example: a hospice patient develops acute symptoms that cannot be managed in the hospice setting and is emergently admitted to the hospital. ^[1]

For outpatient services: the patient presents to the hospital outpatient department (e.g., for a diagnostic test or a procedure) directly from a hospice facility. This might occur when the hospice arranges for a specific outpatient service while the patient remains under hospice care. ^[1]

Do not use code F for:

• A patient who was at home under hospice services but not physically in a hospice facility – use code 1 (non‑health care facility point of origin).
• A patient transferred from a hospital or skilled nursing facility to a hospice facility – that would be the receiving facility’s code.
• A patient coming from an ambulatory surgery center or distinct unit of the same hospital – use codes E or D respectively.

Always verify that the transferring facility is a licensed hospice facility and that the medical record documents the transfer from hospice. ^[1]

Step‑by‑Step Claim Example

Scenario: A 78‑year‑old patient with terminal cancer under the care of “Peaceful Journey Hospice” develops severe shortness of breath. The hospice nurse calls 911 and the patient is transported to City General Hospital’s emergency department (ED). After evaluation, the patient is admitted as an inpatient for respiratory failure.

Step 1 – Identify the patient’s origin: The patient was directly transferred from Peaceful Journey Hospice, a licensed hospice facility. Documentation includes the hospice transfer form and ambulance records showing origin at hospice address.

Step 2 – Select the correct code for Field 15: Use code F. ^[1] The UB‑04 instruction for code F inpatient says “admitted as transfer from hospice.”

Step 3 – Complete other required fields on the UB‑04:

• Field 12 (Patient Name)
• Field 13 (Patient Address)
• Field 14 (Date of Birth)
• Field 16 (Type of Admission – e.g., Emergency)
• Field 17 (Source of Admission – code F)
• Field 18 (Patient Discharge Status – e.g., still inpatient or eventually discharged).
• Field 42‑44 (Revenue Codes, HCPCS, and charges)
• Field 66 (Diagnosis codes)

Step 4 – Submit claim with appropriate modifiers: Because the patient was admitted from hospice, the claim may trigger special hospice‑related payment rules (e.g., the transferring hospice may be responsible for certain services). The billing department should also verify that the hospice transfer agreement is in place and that the patient’s Medicare/Medicaid hospice benefit is coordinated appropriately.

Step 5 – Attach required documentation: If the payer requires, include the hospice transfer form and a copy of the ambulance record to prove the origin. Many payers will audit claims with code F to ensure the patient truly came from a hospice facility and not from home hospice.

Common Mistakes & Audit Red Flags

• Using code F for home‑hospice patients – If the patient receives hospice services at home but is not physically located in a hospice facility at the time of transfer, code 1 (non‑health care facility point of origin) is correct. Using code F incorrectly can lead to claim denials or payment recoupment. ^[1]

• Confusing code F with code 5 or 6 – Code 5 is for SNF, ICF, ALF, or nursing facility transfers; code 6 is for other health care facilities not defined elsewhere. Hospice is a distinct facility type and must use code F. ^[1]

• Missing documentation of hospice status – Auditors frequently look for a signed transfer form or hospice certification. Without it, the claim appears as an unsupported transfer and may be downcoded to code 9 (information not available) or denied.

• Using code F for outpatient services without verifying the patient’s location – If the patient was at a hospice‑arranged clinic but not in the hospice facility itself, code F may still be appropriate if the hospice facility is the official point of origin. However, the medical record must clearly state the patient was “transferred from hospice facility” rather than “referred by hospice MD.” A referral from a hospice physician without physical transfer should use code 1 or 2.

• Not updating Field 16 (Type of Admission) – For inpatient claims, the admission type should match the circumstances (e.g., E for emergency). Using an elective admission type with a hospice transfer may raise questions about medical necessity.

Related Codes/Fields

The following table lists common Point‑of‑Origin codes (Field 15) that may be confused with or used alongside code F. For the complete set, refer to the payer‑specific guidelines. ^[1] | ^[2]

Code	Meaning (Inpatient)	Meaning (Outpatient)
1	Non‑health care facility point of origin (e.g., home, physician referral)	Same; patient comes from home/physician’s office
2	Clinic or physician’s office	Same; presents for outpatient services from clinic
4	Transfer from a hospital (different facility)	Referred for outpatient services by another facility’s physician
5	Transfer from SNF, ICF, ALF, or nursing facility	Referred by physician of SNF/ICF/ALF/NF
6	Transfer from another health care facility not defined elsewhere	Same
F	Transfer from a hospice facility	Came for outpatient services from hospice
E	Transfer from an ambulatory surgery center (ASC)	Same
D	Transfer from one distinct unit to another of the same hospital	Same (separate bill to payer)

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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