UB04 Condition Codes Code 29: Disabled Health Plan is Secondary to Medicare

Overview

Condition code 29 on the UB‑04 claim form indicates that a Disabled Health Plan is Secondary to Medicare. According to the Noridian Condition Codes reference, code 29 is specifically defined as: “Disabled beneficiary and/or family members LGHP is secondary to Medicare” ^[1]. The acronym “LGHP” stands for Large Group Health Plan. This code is entered in Field 18 (Condition Codes) of the UB‑04 to alert the Medicare payer that the patient (or a family member) is a disabled beneficiary covered by a large group health plan, and that plan has been determined to be the secondary payer – meaning Medicare is the primary payer. The code is distinct from condition code 28 (which covers employer group health plans for non‑disabled patients) and from condition code 11 (used when a disabled beneficiary has no large group health plan) ^[1]. Providers must use the correct code to ensure proper coordination of benefits and avoid claim denials. The MassHealth UB‑04 Billing Guide confirms that condition codes are entered in Field 18, and that correct coding is essential for accurate processing ^[2].

When to Use

Use condition code 29 on a UB‑04 claim when all of the following are true:

• The patient is a disabled beneficiary entitled to Medicare (typically under age 65 due to disability).
• The patient (or a family member) is covered by a Large Group Health Plan (LGHP) – generally a group health plan offered by an employer with 100 or more employees.
• Medicare is the primary payer; the LGHP is secondary because the beneficiary is disabled and not covered by the large group health plan on the basis of current employment (or other exceptions apply) ^[1].

This code should not be used for:

• Disabled beneficiaries with no large group health plan (use code 11) ^[1].
• Patients whose employer group health plan (EGHP) is secondary but who are not disabled (use code 28) ^[1].
• Patients with ESRD in the first 30 months of entitlement (use code 06) ^[1].

The condition code must be entered in Field 18 of the UB‑04. If additional condition codes are needed, they can be listed in Fields 18a–18d in priority order ^[2] (see “How to Complete the UB‑04 Claim Form” for field entry instructions).

Step‑by‑Step Claim Example

Scenario: A 55‑year‑old disabled Medicare beneficiary is admitted for inpatient surgery. The patient is covered by a Large Group Health Plan (LGHP) from a former employer (the plan is secondary to Medicare). The facility is billing Medicare as the primary payer.

| Field | Entry | Explanation | Source | |-------|-------|-------------|--------| | Field 1 | Provider name and address | Standard provider information. | | Field 18 | 29 | Enter “29” to indicate “Disabled Health Plan (LGHP) is Secondary to Medicare.” | ^[1] | | Field 50 (Payer Identification) | Line A: Medicare (primary)
Line B: LGHP (secondary) | Sequence must reflect Medicare as primary; the secondary plan is the LGHP. | ^[2] (General Instructions and TPL supplement) | | Field 51 (Provider Data, e.g., NPI) | NPI of facility | Required for all claims. | | Field 56 (National Drug Code, if applicable) | NDC for separately billable drugs | Only if applicable. |

Instructions:

1. In Field 18, place “29” as the first condition code. If other conditions apply (e.g., code 04 for informational bill), list them in Fields 18a–18d, with code 29 always in the primary position ^[2].
2. In Field 50, list Medicare as Payer A (line A) and the LGHP as Payer B (line B) to reflect the correct coordination of benefits sequence.
3. Complete remaining standard fields (diagnosis codes, procedure codes, revenue codes, charges) per MassHealth and Medicare billing instructions.

This claim will be processed by Medicare as primary; Medicare will then forward the claim to the LGHP for secondary payment. Correct use of code 29 ensures that the LGHP is not incorrectly paid as primary ^[1].

Common Mistakes & Audit Red Flags

| Mistake / Red Flag | Why It Occurs | How to Avoid | |--------------------|---------------|--------------| | Using code 29 when the patient is not disabled | Confusion with code 28 (EGHP secondary) or code 06 (ESRD). | Verify that the patient has a Medicare entitlement due to disability (check Medicare card or eligibility system). Use code 28 only if the patient is aged or disabled but the EGHP is secondary for other reasons. | ^[1] | | Using code 29 when the disabled beneficiary has no LGHP | Misunderstanding of the code’s meaning – code 29 specifically requires a Large Group Health Plan. If there is no LGHP, use code 11. | Confirm the patient’s insurance coverage. Code 11 is “Disabled beneficiary but no LGHP.” | ^[1] | | Placing code 29 in the wrong field or omitting it entirely | Condition codes must be in Field 18; incorrect field placement leads to claim rejection. | Follow the UB‑04 form layout. Field 18 is a six‑character field (18a–18f). Enter “29” left‑justified in the first position. | ^[2] (Section “How to Complete the UB‑04 Claim Form”) | | Not listing the LGHP as a secondary payer in Field 50 | Even with condition code 29, the secondary payer must be identified in the payer block. Omitting it may cause the LGHP to be billed incorrectly. | Always list both Medicare (primary) and the LGHP (secondary) in Field 50, with correct sequence. | ^[2] (Appendix A: TPL instructions) | | Using code 29 for ESRD beneficiaries in the first 30 months | Code 06 is specifically for ESRD patients in the coordination period. Code 29 is for disabled beneficiaries with non‑ESRD LGHP. | Screen for ESRD diagnosis. If the patient has ESRD and is in the first 30 months of Medicare entitlement, use code 06, not 29. | ^[1] |

Related Codes/Fields

The following table lists related condition codes and fields that impact coordination of benefits for disabled beneficiaries. All codes are from the Noridian reference and are entered in Field 18 of the UB‑04.

Code	Meaning	Field(s) Used	Source
11	Disabled beneficiary but no LGHP	Field 18	[1]
28	Patients and/or spouses EGHP is secondary to Medicare	Field 18	[1]
29	Disabled beneficiary and/or family members LGHP is secondary to Medicare	Field 18	[1]
06	ESRD patient in the first 30 months of entitlement covered by employer group health insurance	Field 18	[1]
07	Treatment of a non‑terminal condition for a hospice patient	Field 18	[1]
12 (not shown in excerpt)	Not listed in the provided source; check latest Noridian list	Field 18	–
Field 50 (Payer Identification)	Contains payer order (primary, secondary, tertiary)	Fields 50a–50c	[2]
Field 18a–18f	Used for up to six condition codes; primary code should be listed first	Field 18 (subfields)	[2]

Note: Always verify the latest condition code list from Noridian or your local Medicare contractor, as codes may be updated. The table above reflects codes explicitly listed in the provided Noridian excerpt.

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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