UB04 Patient Discharge Status Code 92: Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital readmission

Overview

Patient Discharge Status Code 92 is used when a patient is discharged or transferred to a nursing facility that is certified under Medicaid but not certified under Medicare, and there is a planned acute care hospital inpatient readmission. This code became effective on October 1, 2013 ^[1]. The code specifically indicates that the receiving facility is a nursing facility that meets Medicaid certification requirements but does not hold Medicare certification, distinguishing it from skilled nursing facilities (SNFs) that are Medicare-certified.

This code is part of a series of discharge status codes (81-94) that all include the phrase "with a planned acute care hospital inpatient readmission," which were implemented to provide more granular tracking of patient dispositions that involve an anticipated return to acute care ^[1]. Code 92 is the Medicaid-only nursing facility counterpart to Code 64 (discharge to a nursing facility certified under Medicaid but not certified under Medicare without a planned readmission) and Code 83 (discharge to a Medicare-certified SNF with a planned readmission) ^[1].

The code is used on the UB-04 claim form, which is required for institutional providers such as acute inpatient hospitals when submitting claims to payers like MassHealth ^[2]. Proper use of this code ensures accurate tracking of patient outcomes, appropriate reimbursement, and compliance with reporting requirements.

When to Use

Use Code 92 when all three of the following conditions are met: (1) the patient is discharged or transferred to a nursing facility that is certified under Medicaid but not certified under Medicare, (2) there is a planned acute care hospital inpatient readmission, and (3) the discharge is from an acute care hospital setting ^[1]. This code should not be used if the receiving facility has Medicare certification, even if it also has Medicaid certification—in that case, use Code 83 (discharge to a Medicare-certified SNF with a planned readmission) or Code 63/91 for long-term care hospitals ^[1].

This code is appropriate when the patient requires custodial or supportive care at a Medicaid-only nursing facility, but the clinical team has already planned a future readmission to the acute care hospital for a scheduled procedure, treatment, or intervention. The planned readmission must be documented in the medical record and communicated to the receiving facility. If there is no planned acute care readmission, use Code 64 instead ^[1].

Providers should verify the receiving facility's certification status before selecting this code. The facility must be specifically certified under Medicaid but lack Medicare certification. Facilities that are dually certified or Medicare-only should not be reported with Code 92 ^[1]. This code applies to discharges from acute care hospitals, including inpatient units, and is reported in Field 17 of the UB-04 claim form.

Step-by-Step Claim Example

Scenario: A 78-year-old patient is discharged from General Hospital after treatment for a hip fracture. The patient requires ongoing custodial care at a nursing facility that is certified under Medicaid but not under Medicare. The orthopedic surgeon has scheduled a follow-up surgery in 6 weeks, requiring a planned readmission to General Hospital.

Step 1: Verify the receiving facility's certification. Contact the nursing facility to confirm it is certified under Medicaid but not under Medicare. Document this verification in the medical record.

Step 2: Document the planned readmission. The physician must document in the medical record that a planned acute care hospital readmission is scheduled for the follow-up surgery. Include the date and reason for the planned readmission.

Step 3: Complete Field 17 on the UB-04 claim form. Enter Code 92 in the Patient Discharge Status field (Field 17) of the UB-04 claim form ^[1].

Step 4: Complete other required fields. Ensure all other required fields on the UB-04 are completed, including patient demographics, admission date, discharge date, and diagnosis codes. The UB-04 form is required for institutional claims submitted to payers like MassHealth ^[2].

Step 5: Submit the claim. Submit the completed UB-04 claim form to the appropriate payer (e.g., MassHealth, Medicare, or commercial insurer) according to their specific submission requirements. For MassHealth, electronic submission is required unless a waiver has been approved ^[2].

Step 6: Retain documentation. Keep copies of the claim, the receiving facility's certification verification, and the planned readmission documentation in the patient's medical record for audit purposes.

Common Mistakes & Audit Red Flags

Using Code 92 when the facility is Medicare-certified: This is the most common error. If the nursing facility has any Medicare certification (even if also Medicaid-certified), Code 92 is incorrect. Use Code 83 instead for Medicare-certified SNFs with planned readmissions ^[1].

Using Code 92 without a planned readmission: If there is no planned acute care hospital readmission, use Code 64 (discharge to a Medicaid-only nursing facility without planned readmission) ^[1]. Auditors will look for documentation of the planned readmission in the medical record.

Using Code 92 for non-nursing facility discharges: This code is specifically for nursing facilities certified under Medicaid. Do not use it for discharges to skilled nursing facilities, long-term care hospitals, rehabilitation facilities, or other facility types ^[1].

Failing to document the planned readmission: The planned readmission must be clearly documented in the medical record. Without this documentation, the claim may be denied or flagged for audit. Include the date, reason, and responsible physician for the planned readmission.

Using outdated codes: Code 92 became effective October 1, 2013. Ensure your billing system and staff are using the current code set. Using pre-2013 codes may result in claim rejection ^[1].

Incorrect claim form submission: For MassHealth, all claims must be submitted electronically unless a waiver has been approved. Submitting paper claims without a waiver may result in denial ^[2].

Related Codes/Fields

Code	Meaning	Relationship to Code 92
64	Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare	Same facility type but without planned readmission
83	Discharged/transferred to a SNF with Medicare certification with planned acute care readmission	Same readmission status but for Medicare-certified SNF
92	Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with planned acute care readmission	Current code
02	Discharged/transferred to a short-term general hospital for inpatient care	Different facility type (hospital) without planned readmission
82	Discharged/transferred to a short-term general hospital for inpatient care with planned acute care readmission	Different facility type with planned readmission
04	Discharged/transferred to a facility that provides custodial or supportive care	Broader category that may include some nursing facilities
84	Discharged/transferred to a facility that provides custodial or supportive care with planned acute care readmission	Broader category with planned readmission
01	Discharged to home or self-care (routine discharge)	Different disposition (home) without planned readmission
81	Discharged to home or self-care with planned acute care readmission	Different disposition (home) with planned readmission

^[1]

---

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