UB04 Patient Discharge Status Code 94: Discharged/transferred to a Critical Access Hospital (CAH) with a planned acute care hospital readmission

Overview

Patient Discharge Status Code 94 is defined as “Discharged/transferred to a Critical Access Hospital (CAH) with a planned acute care hospital inpatient readmission” ^[1]. This code is part of the “with planned acute care hospital inpatient readmission” series that became effective October 1, 2013, as documented on the Noridian source list ^[1]. The code applies when a patient is discharged from an acute care hospital and transferred to a Critical Access Hospital (CAH) with a specific plan for the patient to be readmitted to an acute care hospital for inpatient care. CAHs are rural hospitals that receive cost-based reimbursement from Medicare and are limited to 25 beds. The “planned acute care hospital inpatient readmission” component distinguishes this code from code 66, which also signifies transfer to a CAH but without an explicit plan for acute care readmission ^[1]. The Noridian source lists code 94 with the note “(effective 1” – likely indicating October 1, 2013, as with other codes in the same series, but the source text truncates the date ^[1]. Providers must ensure that the transfer to the CAH is clinically appropriate and that the planned acute care readmission is documented in the medical record to support use of this status code.

When to Use

Code 94 should be used when a patient is discharged from an acute care hospital and transferred to a Critical Access Hospital (CAH) and there is a documented plan for a subsequent acute care hospital inpatient readmission ^[1]. This scenario typically occurs when a patient requires a short stay at a CAH for stabilization, observation, or further assessment before returning to the original hospital or another acute care facility for a planned procedure or continued inpatient care. The CAH must be a Medicare-certified Critical Access Hospital, and the planned acute care readmission must be part of the patient’s treatment plan at the time of discharge from the original hospital. The code is effective October 1, 2013, per the Noridian source ^[1]. It is important not to use code 94 when there is no planned acute care readmission; in such cases, code 66 (discharged/transferred to a CAH) is appropriate ^[1]. Code 94 applies only to inpatient discharges from an acute care hospital. The MassHealth UB-04 Billing Guide does not specifically address code 94 but provides general instructions for completing the form, including the use of official code sets ^[2]. Providers should follow payer-specific guidelines (e.g., Medicare, MassHealth) when submitting claims with code 94.

Step-by-Step Claim Example

A 72-year-old patient is admitted to an acute care hospital for congestive heart failure exacerbation. After three days, the patient is stable but still requires monitoring for fluid balance and medication adjustment. The attending physician determines that the patient can be transferred to a Critical Access Hospital (CAH) 20 miles away for four days of observation, with a plan to readmit the patient to the original acute care hospital for a scheduled cardiac catheterization after the CAH stay. This meets the criteria for code 94. On the UB-04 claim form, the following fields are completed:

• Field 17 (Patient Discharge Status): Enter “94” to indicate discharge/transfer to a CAH with planned acute care readmission ^[1].
• Field 14 (Admission Date): Enter the original acute care admission date.
• Field 15 (Discharge Hour): Enter the hour of discharge per standard format.
• Field 16 (Discharge Date): Enter the date of transfer to the CAH.
• Field 22 (Patient Status): Confirm the patient did not expire; code 20 not applicable.
• Field 61 (Diagnosis Codes): List the principal diagnosis (e.g., I50.9) and relevant secondary diagnoses.

The medical record must contain a clear note documenting the plan for acute care readmission (e.g., “Patient to be transferred to ABC CAH for monitoring, with planned readmission to this facility on [date] for cardiac catheterization”). This documentation supports the use of code 94 and helps avoid audit issues ^[1]. The billing office should verify that the CAH is Medicare-certified and that the readmission is scheduled or clinically anticipated.

Common Mistakes & Audit Red Flags

A common mistake is using code 94 when there is no documented plan for acute care inpatient readmission. The Noridian source emphasizes that code 94 is specifically for “with a planned acute care hospital inpatient readmission” ^[1]. If the plan is only for observation or outpatient follow-up at the CAH, code 66 (discharged/transferred to a CAH) should be used instead. Another error is using code 94 for transfers to non-CAH facilities, such as skilled nursing facilities (SNF) or inpatient rehabilitation facilities (IRF). Each facility type has its own discharge status code (e.g., code 02 for short-term general hospital, code 62 for IRF). Using code 94 for a CAH transfer without a planned readmission may trigger an audit red flag because the claim implies a readmission that never occurs or is not documented. Providers should ensure that the medical record includes a specific plan for acute care readmission, including timing and reason. Failure to document this plan could result in claim denials or overpayment recoupment ^[1]. Additionally, effective dates matter: code 94 was not valid before October 1, 2013; using it for earlier discharges is incorrect. The MassHealth UB-04 guide does not list code 94 specifically, but providers should adhere to national standards ^[2]. Audit red flags also include inconsistent use of code 94 with other fields, such as field 14 (admission) and field 16 (discharge) not matching the expected length of stay, or missing a principal diagnosis that supports the need for transfer and planned readmission.

Related Codes/Fields

The following table lists patient discharge status codes in the “with planned acute care hospital inpatient readmission” series, including code 94, as documented by Noridian ^[1]. Note that codes 81-93 correspond to other destination types with planned readmission.

Code	Meaning	Effective Date
81	Discharged to home/self-care with planned acute care readmission	10/1/13
82	Discharged/transferred to short-term general hospital with planned readmission	10/1/13
83	Discharged/transferred to SNF (Medicare) with planned readmission	10/1/13
84	Discharged/transferred to custodial/supportive care with planned readmission	10/1/13
85	Discharged/transferred to cancer center/children’s hospital with planned readmission	10/1/13
86	Discharged/transferred to home health with planned readmission	10/1/13
87	Discharged/transferred to court/law enforcement with planned readmission	10/1/13
88	Discharged/transferred to federal health care facility with planned readmission	10/1/13
89	Discharged/transferred to hospital-based swing bed with planned readmission	10/1/13
90	Discharged/transferred to IRF (inpatient rehabilitation) with planned readmission	10/1/13
91	Discharged/transferred to LTCH with planned readmission	10/1/13
92	Discharged/transferred to Medicaid-only nursing facility with planned readmission	10/1/13
93	Discharged/transferred to psychiatric hospital/unit with planned readmission	10/1/13
94	Discharged/transferred to Critical Access Hospital (CAH) with planned readmission	10/1/13*

*The Noridian source lists “effective 1” for code 94, likely meaning October 1, 2013, consistent with other codes in this series ^[1]. Providers should always verify effective dates with their Medicare Administrative Contractor.

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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