UB04 Condition Codes Code 55: SNF Bed Not Available

Overview

Condition Code 55 indicates that a skilled nursing facility (SNF) bed is not available for a Medicare beneficiary who requires SNF-level care. This code is used to document that the patient is receiving covered SNF services in an acute care hospital or another appropriate setting because no SNF bed could be secured within a reasonable timeframe. ^[1]

When a hospital or provider submits a claim with Condition Code 55, it signals to the payer that the beneficiary is being held in a location that is not an SNF due to a documented lack of available SNF beds. This situation typically occurs when a patient has exhausted their Medicare Part A inpatient hospital benefits or no longer requires acute care but cannot be discharged to an SNF because all local facilities are full. The code is payer-specific and is commonly used by Medicare Administrative Contractors (MACs) and state Medicaid agencies to justify payment for services provided outside the typical SNF environment. ^[2]

When to Use

Condition Code 55 should be used when a Medicare beneficiary requires SNF-level care but no SNF bed is available in the patient’s geographic area. This includes instances where the patient is ready for discharge from an acute care hospital but cannot be placed due to a documented bed shortage at all local SNFs. The code is also appropriate when the patient is transferred to a swing bed in a critical access hospital or another alternative setting because an SNF bed is unavailable. ^[1]

The code is particularly relevant for hospitals that are not PPS-exempt and do not have their own SNF unit. For example, a patient who no longer meets inpatient acute care criteria but still requires daily skilled nursing or therapy services would be a candidate. The provider must document their efforts to locate an SNF bed, including contacting multiple facilities and recording their responses. Use this code only when the unavailability of a bed is the sole reason for the patient remaining in the current setting. If the patient declines SNF placement or has other barriers (e.g., family request), Condition Code 55 is not appropriate. ^[2]

Step-by-Step Claim Example

Scenario: A 78-year-old Medicare beneficiary is admitted to an acute care hospital for a hip fracture repair. The patient improves and is determined to no longer meet inpatient acute care criteria on day five but still requires daily skilled nursing and physical therapy. The hospital’s case manager contacts five local SNFs—all report no vacant beds for the next two weeks. The patient cannot be discharged home safely.

Step 1: Document all SNF contacts in the patient’s medical record, including facility names, dates, telephone numbers, and the reasons for denial (e.g., “no beds available”). Obtain a written or electronic log of contacts. ^[1]

Step 2: On the UB-04 claim form, locate Form Locator 18-28 (Condition Codes) . Enter 55 in the first available position of this block. If other condition codes also apply (e.g., Code 57 for SNF readmission), list them in subsequent positions. ^[2]

Step 3: In Form Locator 44 (Date) , enter the date the patient was determined to no longer require acute care but SNF care began (the date the bed was needed). In Form Locator 45 (Service Date) , use the date span during which SNF-level services were provided in the hospital setting.

Step 4: In Form Locator 66 (Diagnosis and Procedure Codes) , list the primary diagnosis (e.g., hip fracture) and any comorbidities. Ensure the diagnosis codes reflect the need for continued skilled care, not acute medical necessity.

Step 5: Submit the claim with a remark to the payer explaining the bed unavailability. Use Form Locator 80 (Remarks) to note “SNF BED NOT AVAILABLE PER DOCUMENTED CONTACTS.” The claim will be processed under Medicare Part A (if the patient has days remaining) or Part B (if the beneficiary has exhausted Part A benefits). ^[1]

Common Mistakes & Audit Red Flags

Mistake 1: Using Code 55 without documentation. Payers, especially MACs like Noridian, will deny the claim if the medical record does not contain evidence of attempted SNF placement. Providers must retain a written log of contacts, including facility names, dates, and reasons for denial. This is a frequent audit target. ^[1]

Mistake 2: Using Code 55 for patient refusal. If the patient or family declines SNF placement (e.g., wants to go home), Code 55 is inappropriate. Instead, use Code 42 (Continued care plan not related to inpatient admission) or other relevant codes. Misuse can result in overpayment demands.

Mistake 3: Failing to coordinate with Medicare billing rules. Condition Code 55 must align with the patient’s Medicare benefit status. If the patient has no Part A days remaining, the claim may fall under Part B, requiring different revenue codes and payment rules. Incorrect coding can cause duplicate billing or payment errors.

Mistake 4: Not updating the code after bed availability. If an SNF bed becomes available later in the same stay, the provider should not continue using Code 55. The code is valid only for periods when a bed was genuinely unavailable. Retroactively removing Code 55 after final claim submission may be necessary.

Audit Red Flags: Multiple consecutive claims with Code 55 for the same patient, especially when other local SNFs have available beds; lack of substantiating documentation; and use of Code 55 alongside other codes that indicate the patient refused discharge (e.g., Code 42). Payers may request medical records for every claim with Code 55. ^[2]

Related Codes/Fields

The following table shows condition codes commonly used with or related to Code 55, along with relevant UB-04 form locators.

Code/Field	Name	Relationship to Code 55
Code 56	Medical appropriateness condition code (SNF)	Used when an SNF bed is available but the patient cannot be transferred for medical reasons (e.g., unstable condition)
Code 57	SNF readmission within 30 days	Used when a patient is readmitted to the hospital within 30 days of a prior SNF discharge
Form Locator 44	Date of discharge/transfer	Enter the date the patient was determined ready for SNF care; essential for billing SNF-level services
Form Locator 45	Service dates	Must reflect the period during which SNF-level care was delivered outside an SNF
Form Locator 66	Diagnosis codes	Should support the need for ongoing skilled care (e.g., rehabilitation codes)
Revenue Code 045x	Emergency Room	Not used with Code 55; avoid if the patient is receiving skilled services, not emergency care
Revenue Code 012x	Room and board (general)	Use for daily hospital stay when SNF care is provided; do not use Code 012x for SNF patients

^[1], ^[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