UB04 Condition Codes Code 20: Beneficiary Requested Billing

Overview

Condition codes are special indicators entered on the UB-04 claim form to convey circumstances affecting billing or payment. The MassHealth UB-04 Billing Guide confirms that the UB-04 is used by acute inpatient hospitals, acute outpatient hospitals, and other provider types submitting paper claims ^[1]. Among the condition codes recognized by Medicare, code 20 is defined as "Beneficiary requested billing" according to the Noridian Condition Codes list for Jurisdiction E (JE) Part A ^[2]. This code signals that the beneficiary asked the provider to submit a claim to a specific payer or to initiate billing for a particular service episode. It is one of many codes (ranging from 01 through 77 in the Noridian list) that help payers process claims correctly and identify special billing arrangements.

When to Use

Code 20 should be entered on the UB-04 claim form when the beneficiary has explicitly requested that the provider bill for services. The Noridian Condition Codes list places this code among other patient‑initiated indicators, such as code 08 (“Beneficiary would not provide information concerning other insurance coverage”) and code 21 (“Billing for denial notice”) ^[2]. Use code 20 when the beneficiary’s request is documented and the provider is acting on that request to submit a claim—for example, when the beneficiary asks the provider to bill Medicare directly rather than a secondary insurer. The code does not specify which payer is targeted; it only records that the beneficiary initiated the billing process. Providers should verify that the request is consistent with the beneficiary’s coverage and that applicable billing rules (e.g., Medicare timely filing limits) are followed. The MassHealth guide outlines general UB‑04 completion instructions, but code‑specific guidance should be obtained from the applicable payer’s condition code list, such as Noridian’s for Medicare Part A .

Step‑by‑Step Claim Example

A Medicare beneficiary is treated at an acute inpatient hospital (a provider type listed in the MassHealth guide). The beneficiary informs the hospital’s billing office that he wants the claim submitted to Medicare Part A, rather than relying on a secondary insurer to handle it. The hospital documents the request in the medical record. On the UB‑04 form, the hospital enters condition code 20 in the appropriate condition code field (field 18–28 per standard UB‑04 layout). The code is selected from the Noridian Condition Code list, which explicitly defines code 20 as “Beneficiary requested billing” ^[2]. No other condition codes related to the beneficiary’s request need to be added unless additional circumstances (such as workers’ compensation or a lien) also apply. The claim is then submitted to the Medicare contractor. The contractor identifies the beneficiary‑requested billing condition and processes the claim accordingly.

Common Mistakes & Audit Red Flags

Because code 20 carries specific payer implications, incorrect use can lead to claim rejections or audit scrutiny. Common mistakes include:

• Using code 20 when the beneficiary has not explicitly requested billing. The Noridian list distinguishes “Beneficiary requested billing” from codes like 08 (beneficiary refused to provide insurance info) or 21 (billing for denial notice) ^[2]. Applying the wrong code misrepresents the situation.
• Omitting code 20 when required. If the beneficiary’s request is the reason the claim is being submitted to a particular payer, failing to include code 20 may result in the claim being misrouted or denied.
• Inconsistent documentation. Although the Noridian source does not list documentation requirements, auditors often expect a written or recorded beneficiary request. Providers should follow their own payer’s guidelines. The MassHealth guide emphasizes correct claim completion, and any mismatch between the condition code and the medical record may trigger a review.

To reduce audit risk, always verify that the beneficiary’s request is documented and that no other condition code better describes the billing scenario (e.g., code 02 for workers’ compensation-related episodes) ^[2].

Related Codes/Fields

The table below lists condition codes from the Noridian list that are conceptually related to beneficiary actions or billing requests. All codes and descriptions are taken directly from the Noridian Condition Codes source ^[2].

Code	Description	Source
08	Beneficiary would not provide information concerning other insurance coverage	[2]
09	Neither the patient nor the spouse is employed	[2]
10	Patient and/or spouse is employed but no EGHP coverage exists	[2]
11	Disabled beneficiary but no LGHP	[2]
20	Beneficiary requested billing	[2]
21	Billing for denial notice	[2]
67	Beneficiary elects not to use LTR days	[2]
68	Beneficiary elects to use LTR days	[2]

These codes are entered on the UB-04 claim form (field 18–28, as implied by standard form design, though not explicitly stated in the provided sources). Providers should consult their specific payer’s condition code list to confirm the exact field location and any additional instructions.

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References

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

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