UB04 Patient Discharge Status Code 43: Discharged/transferred to a federal health care facility

Overview

When to Use

Code 43 should be used when a patient is discharged from a hospital and transferred directly to a facility operated by the federal government. ^[1] Common examples include transfer to a VA medical center, a Department of Defense hospital, an Indian Health Service facility, or a federal prison hospital. It is also appropriate when the patient is discharged to a federal long-term care facility or a federal psychiatric hospital. ^[1] If the transfer to a federal health care facility is part of a planned acute care hospital inpatient readmission, code 88 must be used instead of code 43. ^[1] Code 43 is not appropriate for transfers to state-run facilities (e.g., state veterans homes, state psychiatric hospitals) or to non-federal facilities such as skilled nursing facilities or rehabilitation hospitals. The MassHealth UB-04 guide emphasizes that providers must use the correct code sets when completing the claim form. ^[2] Accurate coding is essential for proper claims processing and to avoid denials.

Step-by-Step Claim Example

Consider a patient admitted to a general acute care hospital for a hip fracture. After surgery and stabilization, the patient is transferred to a Veterans Administration (VA) hospital for continued rehabilitation. The hospital completes the UB-04 claim form as follows:

• Field 12 (Patient Name): Enter the patient’s full name as it appears on the insurance card.
• Field 17 (Patient Discharge Status): Enter “43” to indicate discharge/transfer to a federal health care facility. ^[1]
• Field 22 (Patient Status): Not used for discharge status; leave blank or as instructed by payer.
• Field 23 (Medical Record Number): Enter the hospital’s internal medical record number.
• Field 56 (NPI): Enter the hospital’s National Provider Identifier.
• Field 58 (Insured’s Name): Enter the patient’s name again if different from Field 12.
• Field 66 (Diagnosis Code Pointer): Link the principal diagnosis to the appropriate revenue lines.

The MassHealth UB-04 guide instructs providers to complete all required fields accurately and to refer to the code sets for patient discharge status. ^[2] The claim is then submitted electronically or on paper if a waiver has been granted. ^[2] Using code 43 correctly ensures the VA hospital is identified as the receiving facility, and the claim will be processed accordingly.

Common Mistakes & Audit Red Flags

One frequent error is using code 43 for transfers to non-federal facilities, such as state-run veterans homes or county hospitals. ^[1] Another mistake is using code 43 when the patient is discharged to a federal facility with a planned acute care readmission; in that scenario, code 88 is required. ^[1] Auditors may flag claims where the discharge status code does not match the receiving facility type documented in the medical record. For example, if the record shows transfer to a VA hospital but code 02 (short-term general hospital) is used, the claim may be denied or subjected to review. Additionally, providers sometimes omit the federal facility’s name and address from the claim, which can lead to processing delays. The MassHealth UB-04 guide stresses the importance of using correct code sets and completing all required fields. ^[2] To avoid red flags, always verify the receiving facility’s federal status and confirm whether a planned readmission exists before selecting code 43 or 88.

Related Codes/Fields

The table below lists patient discharge status codes related to code 43, as defined by the NUBC and published by Noridian. ^[1] All codes are entered in UB-04 Field 17.

Code	Meaning	Notes
43	Discharged/transferred to a federal health care facility	Use for VA, military, IHS, federal prison facilities
88	Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission	Effective 10/1/13; use when readmission is planned
02	Discharged/transferred to a short-term general hospital for inpatient care	For non-federal acute hospitals
03	Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification	For Medicare-certified SNFs
04	Discharged/transferred to a facility that provides custodial or supportive care	For non-skilled nursing facilities
05	Discharged/transferred to a designated cancer center or children's hospital	Specialty facilities
06	Discharged/transferred to home under care of organized home health service organization	For home health with skilled care
07	Left against medical advice or discontinued care	Not a transfer
20	Expired	Patient died in hospital
50	Hospice – home	For hospice care at home
51	Hospice – medical facility (certified)	For hospice in a facility
61	Discharged/transferred to a hospital-based Medicare approved swing bed	Swing bed status
62	Discharged/transferred to an inpatient rehabilitation facility (IRF)	Including rehab distinct part units
63	Discharged/transferred to a Medicare certified long term care hospital (LTCH)	LTCHs
64	Discharged/transferred to a nursing facility certified under Medicaid but not Medicare	Medicaid-only nursing facility
65	Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit	Psychiatric facilities
66	Discharged/transferred to a critical access hospital (CAH)	CAHs
70	Discharged/transferred to another type of health care institution not defined elsewhere	Catch-all for other institutions

The MassHealth UB-04 guide references code sets but does not list individual codes; providers should refer to the NUBC or payer-specific manuals for complete listings. ^[2]

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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