UB04 Patient Discharge Status Code 05: Discharged/transferred to a designated cancer center or children's hospital

Overview

Patient discharge status code 05 is used on the UB‑04 claim form to indicate that a patient was discharged or transferred to a designated cancer center or children’s hospital. This code appears in Form Locator 17 of the UB‑04. According to the Noridian Medicare list, code 05 is defined as “Discharged/transferred to a designated cancer center or children’s hospital” ^[1]. The UB‑04 claim form is the standard paper form used by institutional providers, including acute inpatient hospitals, to submit claims to payers such as Medicare and MassHealth ^[2]. Accurate reporting of the discharge status code is essential for correct reimbursement and statistical tracking. Code 05 specifically applies when the receiving facility meets the definition of a “designated cancer center” (e.g., an NCI‑designated comprehensive cancer center) or a children’s hospital that is separately licensed and recognized as a specialty pediatric facility. Providers must ensure the receiving facility qualifies under these criteria before selecting code 05.

When to Use

Code 05 should be used when a patient leaves the hospital and is admitted directly to a facility that is a designated cancer center or a children’s hospital. The designation “cancer center” typically refers to institutions recognized by the National Cancer Institute (NCI) or similar accrediting bodies. Children’s hospitals are those primarily providing inpatient care to pediatric patients and are often free‑standing or distinct part units. The Noridian list includes code 05 without further restriction, so the decision is based on the receiving facility’s classification ^[1]. This code is not appropriate for transfers to general acute care hospitals, skilled nursing facilities, or other non‑specialty settings. When the transfer is part of a planned acute care hospital inpatient readmission, the provider should use code 85 instead of code 05, as noted in the same Noridian list: “85: Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission (effective 10/1/13)” ^[1]. Therefore, code 05 is reserved for transfers where no immediate planned readmission to the original hospital is anticipated. The UB‑04 form’s instructions from MassHealth emphasize that all claims must be submitted electronically unless a waiver is granted, but when paper claims are used, correct completion of each field—including discharge status—is mandatory ^[2].

Step-by-Step Claim Example

Consider a patient admitted to a general acute care hospital for management of a complex pediatric brain tumor. After stabilization, the medical team determines the child requires specialized oncologic care at a children’s hospital with an NCI‑designated cancer program. The patient is discharged directly to that children’s hospital.

1. Identify the receiving facility: The facility is a free‑standing children’s hospital that also operates a designated cancer center. Because it qualifies as both, code 05 is appropriate.
2. Fill Form Locator 17: On the UB‑04 claim for the initial hospital stay, enter code “05” in the “Patient Discharge Status” field.
3. Verify no planned readmission: The transfer is not part of a planned acute care readmission to the original hospital, so code 85 is not used.
4. Complete the rest of the claim: Populate all other required fields (e.g., patient information, diagnosis codes, procedure codes, dates of service) as specified in the MassHealth UB‑04 Billing Guide ^[2].
5. Submit: Whether electronically or on paper (if waiver granted), finalize the claim with code 05 in FL 17.

This example illustrates the straightforward use of code 05 when the receiving facility meets the “designated cancer center or children’s hospital” definition from Noridian ^[1].

Common Mistakes & Audit Red Flags

One frequent error is using code 05 for transfers to a general hospital that has a cancer unit but is not itself a designated cancer center. The code requires the entire receiving facility to be a designated cancer center or children’s hospital. Using code 05 in such cases may trigger audit flags or claim denials. Another mistake is failing to differentiate between code 05 and code 85. If the discharge is part of a planned readmission to the original hospital within a short time frame, code 85 is required; using code 05 instead will appear incorrect during claims review ^[1]. Additionally, some providers incorrectly use code 05 when the patient is transferred to a skilled nursing facility that offers cancer care but is not a designated cancer center. Auditors look for consistency between the discharge status code and the facility information reported in other fields, such as the “Beneficiary Name” and “Other Provider ID” fields. The MassHealth UB‑04 guide stresses the importance of accurate coding to avoid payment delays ^[2]. Providers should maintain documentation of the receiving facility’s designation (e.g., NCI designation letter, license as a children’s hospital) to support code 05 in case of audit.

Related Codes/Fields

The table below lists discharge status codes from the Noridian list that are closely related to code 05, including the version with a planned readmission.

Code	Meaning	Effective Date
02	Discharged/transferred to a short-term general hospital for inpatient care	N/A
05	Discharged/transferred to a designated cancer center or children’s hospital	N/A
06	Discharged/transferred to home under care of organized home health service organization	N/A
43	Discharged/transferred to a federal health care facility	N/A
65	Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit	N/A
85	Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission	10/1/13
86	Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission	10/1/13

Source for all codes: ^[1]. The UB‑04 form also contains a field for “Patient Discharge Status” in Form Locator 17, and the MassHealth guide confirms that all code sets must be used correctly when completing the paper UB‑04 ^[2]. Providers should refer to the full list for other codes that may apply to different transfer scenarios.

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References

[1] Noridian Patient Status — https://med.noridianmedicare.com/web/jea/topics/claim-submission/patient-discharge-status-codes

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