UB04 Patient Discharge Status Code 63: Discharged/transferred to a Medicare certified long term care hospital (LTCH)

Overview

Patient Discharge Status Code 63 is used on the UB‑04 claim form to indicate that the patient was discharged or transferred to a Medicare‑certified long term care hospital (LTCH) ^[1]. This code is one of the standardized patient status codes maintained by Medicare contractors and is recognized across all UB‑04 claim submissions. Code 63 specifically refers to a discharge to a long‑term care hospital that meets Medicare certification requirements, as distinct from a skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), or a nursing facility certified only under Medicaid ^[1].

When to Use

Code 63 should be used when a patient is discharged or transferred from an acute care hospital (or other inpatient setting) directly to a long term care hospital (LTCH) that holds Medicare certification. The code is appropriate only when the receiving facility is Medicare‑certified as an LTCH; if the facility is certified only under Medicaid or not certified at all, different codes apply (e.g., code 64 for a Medicaid‑only nursing facility, or code 04 for custodial/supportive care) ^[1]. It is also important to distinguish code 63 from code 62 (discharge to an IRF) and code 03 (discharge to a Medicare‑certified SNF) ^[1]. When a planned acute care hospital inpatient readmission is expected after the LTCH stay, the appropriate code is 91, not 63 ^[1].

Step‑by‑Step Claim Example

A patient is admitted to an acute care hospital for sepsis and respiratory failure. After stabilization, the physician determines the patient requires prolonged weaning from mechanical ventilation and complex wound care that can best be provided at a Medicare‑certified long term care hospital. The hospital arranges a direct transfer to an LTCH. On the UB‑04 claim form, the billing staff completes the Patient Discharge Status field (field 17) with code 63. According to the Noridian patient status code list, code 63 means “Discharged/transferred to a Medicare certified long term care hospital (LTCH)” ^[1]. The remaining fields of the claim (e.g., patient demographics, admission date, discharge date, principal diagnosis, procedures, revenue codes, and charges) are completed in accordance with the payer’s billing guide. For MassHealth, the UB‑04 must be submitted as instructed in the MassHealth UB‑04 Billing Guide, which provides detailed instructions for completing each field and code set ^[2]. The claim is then submitted electronically (or on paper if a waiver is obtained) for processing. Accurate entry of code 63 confirms to the payer that the patient was transferred to a Medicare‑certified LTCH, which may affect reimbursement rates and DRG assignment.

Common Mistakes & Audit Red Flags

One frequent error is using code 63 when the receiving facility is a long term care hospital that is not Medicare‑certified. In such cases, a different code should be used (e.g., code 04 for custodial care or code 64 for a Medicaid‑only nursing facility) ^[1]. Another mistake is confusing code 63 with code 62 (IRF) or code 03 (SNF) when the patient requires similar but distinct levels of care; each code has specific Medicare certification requirements ^[1]. Auditors will scrutinize discharge status codes for consistency with the patient’s discharge plan, medical necessity, and the type of facility named on the claim. If the provider bills code 63 but the LTCH is not listed in Medicare’s certification database, the claim may be denied or adjusted. Additionally, if a planned acute care readmission is scheduled after the LTCH stay, the provider must use code 91, not 63; using the wrong code could trigger a review for potential overpayment ^[1]. The MassHealth UB‑04 Guide emphasizes the importance of following the official code sets and instructions to avoid claim rejections ^[2]. Providers should also ensure that the discharge status code matches the facility name and type reported in the claim’s other fields, such as field 23 (Provider ID of the receiving facility) if required.

Related Codes/Fields

The table below lists discharge status codes that are directly related to code 63, along with the field where these codes are reported on the UB‑04 form.

Code	Meaning	Field on UB‑04	Source
63	Discharged/transferred to a Medicare certified long term care hospital (LTCH)	Field 17 – Patient Discharge Status	[1]
62	Discharged/transferred to an inpatient rehabilitation facility (IRF)	Field 17	[1]
64	Discharged/transferred to a nursing facility certified under Medicaid but not under Medicare	Field 17	[1]
91	Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission	Field 17	[1]
03	Discharged/transferred to skilled nursing facility (SNF) with Medicare certification	Field 17	[1]

The UB‑04 form contains field 17 for reporting the Patient Discharge Status code. Accurate completion of this field is critical for proper reimbursement and quality‑measure reporting ^[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