UB04 Condition Codes Code 37: Ward Accommodation as a Medical Necessity

Overview

Condition Code 37 is a UB‑04 billing code defined as “Ward accommodation at patients request (Not used by PPS Hospitals).” ^[1] This code is used to indicate that the patient voluntarily chose to be placed in a ward (multi‑bed) room rather than a private or semi‑private room. The code explicitly states that it is not used by Prospective Payment System (PPS) hospitals – meaning facilities that are reimbursed under Medicare’s inpatient PPS (e.g., most acute care hospitals) cannot report this code. It is typically applicable only to non‑PPS facilities such as critical access hospitals, psychiatric hospitals, or rehabilitation units that are paid under alternative methodologies. The code signals that the ward accommodation was the patient’s own request, not a medical necessity or a lack of other bed types. Providers must ensure they are billing under the correct payment system before using this code, as improper use may lead to claim rejections or audits.

When to Use

Use Condition Code 37 only when the patient explicitly requests a ward (multi‑bed) room and the facility is not a PPS hospital. ^[1] Common scenarios include:

• A patient in a critical access hospital (CAH) or a psychiatric facility chooses a ward bed to reduce out‑of‑pocket costs or for personal preference.
• The facility offers multiple room types, and the patient signs a waiver or consent form selecting ward accommodation.
• The ward bed is available and the patient declines a semi‑private or private room.

The code should not be used when the ward placement is due to medical necessity (e.g., isolation for infection control) or when no other bed type is available. In those cases, different condition codes (e.g., Code 38 – Semi‑private room not available, or Code 39 – Private room medically necessary) would be more appropriate. Also, PPS hospitals must never report Code 37; if a Medicare‑certified PPS hospital receives a patient request for a ward bed, they should not use this code because the code is explicitly excluded for their payment system.

Step‑by‑Step Claim Example

A 72‑year‑old patient is admitted to a Critical Access Hospital (CAH) for pneumonia. The CAH offers private, semi‑private, and ward rooms. The patient, concerned about cost, requests a ward bed. The provider obtains a signed patient request form.

Step 1: On the UB‑04 claim form, locate the Condition Code field (typically Form Locators 18–28). Enter 37 in one of the available condition code slots. ^[1]

Step 2: In the revenue code section (FL 42–47), report the appropriate room and board revenue code for ward accommodation (e.g., Revenue Code 0140 – General Ward). The charge should reflect the ward rate.

Step 3: In the statement covers period (FL 6), enter the admission and discharge dates.

Step 4: In the patient name and ID fields (FL 8–10), enter the patient’s information as usual.

Step 5: Submit the claim to the payer (e.g., Medicare Part A for CAH). The payer will recognize Code 37 and process the claim under the non‑PPS payment rules.

Note: The provider must retain the patient’s written request for ward accommodation in the medical record to support the code in case of an audit.

Common Mistakes & Audit Red Flags

• Using Code 37 in a PPS hospital: This is the most frequent error. The code explicitly states “Not used by PPS Hospitals.” ^[1] If a PPS hospital reports it, the claim will be rejected or denied, and the provider may face recoupment.
• Confusing patient request with medical necessity: Code 37 is for patient choice, not for a medically necessary ward placement. If the ward is required due to isolation, infection control, or lack of other beds, use Code 38 or 39 instead. Using Code 37 incorrectly can trigger audits for upcoding or misrepresentation.
• Missing documentation: Payers may request the patient’s signed consent or request form. Without it, the code is unsupported and may be disallowed.
• Using Code 37 when the patient did not actually request the ward: For example, if the facility automatically assigns a ward bed due to capacity, Code 37 is inappropriate. The code requires an active patient choice.
• Billing ward accommodation for Medicare Part A in‑patient stays in PPS hospitals: Even if the patient requests a ward, PPS hospitals cannot use this code. They should bill the standard room rate and not use any condition code for room type.

Related Codes/Fields

The following table lists condition codes that are closely related to room accommodation choices. All definitions are from the same Noridian source. ^[1]

Code	Meaning	Notes
36	General care patient in a special unit	Not used by PPS hospitals
37	Ward accommodation at patients request	Not used by PPS hospitals
38	Semi‑private room is not available	Not used by PPS hospitals
39	Private room medically necessary	Not used by PPS hospitals

These codes are all designated as “Not used by PPS Hospitals,” meaning they apply only to non‑PPS facilities. Providers should select the code that best matches the reason for the room assignment: patient request (37), unavailability of a semi‑private room (38), or medical necessity for a private room (39). Code 36 is used when a general care patient is placed in a special unit (e.g., ICU step‑down) but does not require the special unit’s level of care.

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References

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