UB04 Condition Codes Code 01: Military Service Related

Overview

UB-04 Condition Code 01, titled “Military Service Related,” indicates that the patient’s current episode of care is directly tied to prior military service. The official definition requires the provider to “coordinate with the Department of Veterans Affairs (VA).” ^[1]

This code is placed in fields 18–28 of the UB-04 claim form, where up to 11 condition codes may be entered. ^[2] (Page 4 describes the location of condition codes.)

The primary purpose of code 01 is to alert the payer, typically Medicare or a secondary insurer, that the VA may have primary or shared responsibility for the treatment of service-related conditions. By flagging the claim, the provider triggers coordination-of-benefits workflows between Medicare and the VA. Without this code, the claim may be incorrectly processed, leading to delayed or denied payment. Proper use of condition code 01 ensures that the patient’s military service history is transparent to all payers involved.

When to Use

Condition code 01 should be used when the patient’s current medical condition or injury is documented as being related to active military service. This includes conditions that are service-connected, such as combat wounds, exposure to hazardous materials (e.g., Agent Orange, burn pits), or chronic conditions aggravated by service. ^[1]

The provider must coordinate with the Department of Veterans Affairs (VA) before or at the time of billing. This often means verifying the patient’s VA eligibility and determining whether the VA will pay for all or part of the treatment. Code 01 is not appropriate for patients who are simply veterans seeking care for unrelated conditions (e.g., a broken leg from a car accident). In such cases, code 26 (“VA eligible patient chooses to receive services in a Medicare Certified Facility”) may be more suitable. ^[1]

Common situations include: inpatient admissions for PTSD treatment, outpatient visits for hearing loss due to combat noise, or surgeries for orthopedic injuries sustained during deployment. The code should be applied only when the medical record clearly links the episode to military service.

Step-by-Step Claim Example

Consider a 55-year-old male admitted to a hospital for treatment of chronic obstructive pulmonary disease (COPD) linked to inhaling burn-pit smoke during his deployment in Iraq. The provider verifies his VA eligibility through the patient’s signed release and documentation.

• Step 1: In the UB-04 claim form, locate fields 18–28 (Condition Codes). Enter “01” in the first available field (field 18). ^[2] (Page 4 notes that condition codes occupy fields 18–28.)

• Step 2: In field 39‑41 (Value Codes), use value code “12” if the VA is expected to pay a portion, or use value code “PA” for Medicare‑VA coordination.

• Step 3: Ensure the patient’s VA claim number or other identification is in field 62 (Medical Record Number) or field 84 (Remarks) per payer instructions.

• Step 4: Submit the claim to Medicare as primary. Medicare will apply condition code 01 and will process the claim with a note to coordinate with the VA for any service-connected portion.

• Result: The use of code 01 avoids duplicate billing and ensures the VA is informed of the service, reducing the risk of denial. ^[1] (The code explicitly states to coordinate with the VA.)

Common Mistakes & Audit Red Flags

Mistake 1: Using code 01 for all veterans. Only service-related conditions qualify. If a veteran is treated for a non‑service‑connected illness (e.g., routine appendicitis), code 26 or none should be used. Using code 01 inappropriately can trigger audits for false claims. ^[1] (Code 26 is for VA-eligible patients choosing Medicare facilities.)

Mistake 2: Failing to coordinate with the VA. The definition of code 01 includes an explicit instruction to “coordinate with the Department of Veterans Affairs.” If the provider does not attempt to bill the VA or notify them, the claim may be denied or recouped upon audit.

Audit Red Flag 1: Inconsistent documentation. The medical record must contain a clear link between the condition and military service. Without a physician’s note or certified service-connection status, the code will appear unsupported.

Audit Red Flag 2: Duplicate billing. If the provider bills both Medicare and the VA for the same service without proper coordination (e.g., using code 01 on Medicare), the VA may reject the claim, and Medicare may later demand refund.

Mistake 3: Omitting the code entirely. Providers who are unaware of the patient’s military history may skip the condition code, leading to Medicare paying in full when the VA should have shared the cost. This can result in overpayment recovery actions.

Related Codes/Fields

Code	Meaning	Relation to Code 01
02	Employment environment / workers’ comp	Often confused with military service injuries, but code 01 is specific to VA coordination.
26	VA eligible patient chooses Medicare facility	Used when a patient opts out of VA care for non‑service‑related conditions.
27	Patient referred to sole community hospital for diagnostic lab	May accompany code 01 if referral is for service‑connected testing.
28	EGHP secondary to Medicare	If the veteran also has employer group health plan, coordination rules change.
29	LGHP secondary to Medicare	Similar to 28 but for large group health plans.
46	Nonavailability statement on file	Used when VA facilities are unavailable; may be needed with code 01.
67 / 68	LTR (Long‑Term Care) days elections	Relevant for veterans receiving extended care related to service.
70–76	Dialysis codes (e.g., 70: self‑administered EPO)	Service‑connected renal disease may require combination with code 01.

All codes are sourced from the Noridian condition code list. ^[1]

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References

[1] Noridian Condition Codes — https://med.noridianmedicare.com/web/jea/topics/claim-submission/condition-codes

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