UB04 Condition Codes Code 19: Child of a Female Dependent

Overview

Condition Code 19 on the UB‑04 claim form is defined in the Noridian Condition Codes list as “Child retains mothers maiden name.” ^[1] This code is entered in Form Locators 18–28, the block of fields reserved for condition codes on the UB‑04. ^[2] Condition codes provide supplementary information about the patient’s condition, insurance coverage, or billing situation. Code 19 specifically indicates that the child’s last name is the mother’s maiden name rather than the father’s surname or the mother’s married name. This detail can be essential for correct beneficiary identification, coordination of benefits, and matching the child to a female dependent’s insurance policy. The Noridian list includes code 18 (“Maiden name retained”) for the mother herself; code 19 is the corresponding code for the child. ^[1] Using the correct condition code helps payers process claims accurately and avoid unnecessary denials.

When to Use

Providers should apply Condition Code 19 whenever the patient is a child whose surname is the mother’s maiden name, and that fact is relevant to the claim. ^[1] Common scenarios include: the mother is unmarried and has retained her maiden name; the mother is a dependent on a health policy that uses her maiden name; or the child’s legal surname is the mother’s birth name per state law. This code is especially important when the mother’s condition code 18 (“Maiden name retained”) is also present, as it clarifies the family naming pattern. ^[1] The MassHealth UB-04 Billing Guide instructs providers to complete all applicable condition codes in fields 18–28 based on the patient’s circumstances. ^[2] If the child’s last name does not match the father’s or the mother’s married surname, code 19 should be used to avoid claim mismatches during beneficiary verification. Do not use this code for any other reason, such as step‑parent relationships or guardianship situations that do not involve the mother’s maiden name.

Step-by-Step Claim Example

Consider a claim for a pediatric visit for a child named Emily Garcia, whose mother’s maiden name is Garcia. The mother, Anna Garcia, retained her maiden name after marriage and is listed as the subscriber on a family health plan. The father’s surname is Chen, but Emily’s legal surname is Garcia. On the UB‑04 claim form, the provider enters Condition Code 19 in one of the condition‑code fields (Form Locators 18–28) to indicate “Child retains mothers maiden name.” ^[1] In a separate condition‑code field, the provider also enters Condition Code 18 (“Maiden name retained”) for the mother, because she is the policyholder. ^[1] The patient’s demographic data in Form Locators 8–12 show Emily’s name as Garcia, and the insurance information in Fields 50–55 lists the mother as the subscriber. By using code 19, the biller communicates the naming relationship, helping the payer’s system accurately match the claim to the mother’s policy. The MassHealth UB-04 Guide requires that condition codes be entered left‑to‑right, starting with form locator 18 and using additional fields as needed. ^[2] After submission, the claim processes without a name‑mismatch denial.

Common Mistakes & Audit Red Flags

A frequent error is using Condition Code 19 when the child’s surname is simply the mother’s married name (e.g., she took the father’s name) — that scenario does not involve a “maiden name” and would be incorrect. ^[1] Another mistake is failing to also apply Condition Code 18 for the mother when the mother is the subscriber; the two codes often go together. ^[1] Auditors look for inconsistencies between the condition codes and the patient’s name in Field 12 of the UB‑04. If the child’s surname matches the mother’s maiden name but code 19 is absent, the claim may be flagged for manual review. Conversely, using code 19 without supporting documentation (e.g., the mother’s policy listing her maiden name) can trigger a denial for invalid condition code. Providers should also ensure code 19 is not duplicated across multiple condition‑code fields; each code should be unique on the claim. The MassHealth Billing Guide cautions that all condition codes must be valid and properly entered, or the entire claim may be rejected. ^[2]

Related Codes/Fields

The table below lists condition codes from the Noridian list that are directly related to naming, family status, or insurance coordination, along with relevant UB‑04 form locators. All definitions are taken from the Noridian Condition Codes source. ^[1]

Code	Short Description (Noridian)	Typical Use	UB‑04 Field(s)
18	Maiden name retained	Mother or female subscriber retains birth surname	18–28
19	Child retains mothers maiden name	Child’s surname is mother’s maiden name	18–28
20	Beneficiary requested billing	Patient asked provider to bill specific plan	18–28
21	Billing for denial notice	Claim submitted solely to obtain a denial	18–28
28	Patient’s and/or spouse’s EGHP is secondary to Medicare	Employer group health plan is secondary payer	18–28
29	Disabled beneficiary and/or family member’s LGHP is secondary to Medicare	Large group health plan is secondary payer	18–28

These codes are entered in the condition‑code fields (Form Locators 18–28) on the UB‑04, as outlined in the MassHealth billing instructions. ^[2]

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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