UB04 Condition Codes Code 04: Information Only Bill

Overview

Condition Code 04 is a standardized billing indicator used on the UB-04 claim form to signify that a "Bill is submitted for informational purposes only" ^[1]. This code is part of the Condition Codes set, which are used to identify conditions or events related to the bill that may affect processing ^[2]. When this code is present, it alerts the payer that the claim is not being submitted for primary reimbursement or payment adjudication in the traditional sense, but rather to provide data regarding services rendered to a patient ^[2].

The use of Condition Code 04 is essential for maintaining accurate patient records and ensuring that administrative data is captured by payers without triggering a standard payment cycle ^[2]. This code is utilized across various provider types that use the UB-04 form, including acute inpatient hospitals and acute outpatient hospitals ^[3]. By applying this code, providers fulfill reporting requirements for specific episodes of care where the financial liability may be handled through other mechanisms or where the payer requires a record of the encounter for tracking purposes ^[2].

When to Use

Condition Code 04 must be used whenever a provider submits a claim that is intended for informational purposes rather than for payment ^[2]. This typically occurs in scenarios where the payer needs to be aware of the services provided to a beneficiary, but the actual reimbursement is not expected from that specific claim submission ^[2]. For example, it may be used when reporting services that are covered under a different payment arrangement or when a secondary payer requires a record of the primary payer's involvement without a direct request for funds ^[2].

Providers such as acute inpatient hospitals, acute outpatient hospitals, and hospital-licensed health centers may find it necessary to use this code when submitting paper or electronic claims to satisfy administrative reporting mandates ^[3]. In these instances, the "Information Only" designation ensures the payer's system processes the data without generating an erroneous payment or denial based on standard medical necessity or coverage rules ^[2].

Step-by-Step Claim Example

To properly report an Information Only Bill on the UB-04 form, follow these steps based on standard billing requirements:

1. Identify the Claim Type: Determine if the services rendered require an informational submission rather than a request for payment ^[2].
2. Locate the Condition Codes Field: On the UB-04 claim form, navigate to the designated area for Condition Codes, which are Form Locators 18 through 28 ^[3].
3. Enter Code 04: Enter the digits "04" in the first available Condition Code field to indicate the "Bill is submitted for informational purposes only" ^[2].
4. Complete Required Patient Information: Ensure all other mandatory fields, such as patient name, date of birth, and provider information, are completed as required for standard claim submission ^[3].
5. Submit the Claim: Submit the claim through the appropriate channel, such as the Provider Online Service Center (POSC) or via paper if an electronic claim submission waiver has been approved ^[3].

Common Mistakes & Audit Red Flags

One common mistake is the failure to include Condition Code 04 when a claim is intended only for data tracking, which can lead to inappropriate payments or duplicate billing flags in the payer's system ^[2]. Conversely, applying Code 04 to a claim where reimbursement is actually expected will result in the claim being processed as "information only," meaning no payment will be issued to the provider ^[2].

Another audit red flag involves the inconsistent use of Condition Codes. For example, using Code 04 (Information Only) alongside codes that imply a demand for payment or a specific coverage dispute—such as Code 02 (Employment related injury) or Code 05 (Lien filed)—may cause system edits to reject the claim due to conflicting instructions ^[2]. Providers must also ensure they do not use "Payer Only" codes, such as Code 15 (Clean claim delayed in CMS) or Code 16 (SNF transition exemption), as these are reserved for the payer's internal use and should not be submitted by the provider ^[2]. Finally, submitting paper claims without an approved electronic claim submission waiver is a significant compliance risk, as many payers have adopted all-electronic policies ^[3].

Related Codes/Fields

Code/Field	Meaning/Description
Condition Code 20	Beneficiary requested billing [1].
Condition Code 21	Billing for denial notice [2].
Condition Code 69	IME/DGME/N&AH payment only billing [2].
Condition Code 03	Patient is covered by an insurance not reflected here [2].
Form Locators 18-28	The specific fields on the UB-04 form where Condition Codes are entered [3].
Condition Code 64	Other than clean claim [2].

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References

[1] Condition Codes - JE Part A - Noridian Healthcare Solutions — https://med.noridianmedicare.com/web/jea/topics/claim-submission/

[2] Condition Codes - JE Part A - Noridian Healthcare Solutions — https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types

[3] BG-UB-04 (02/21) MassHealth Billing Guide for the UB-04 — https://www.mass.gov/doc/ub-04-billing-guide-0/download