UB04 Condition Codes Code 62: Payer Code

Overview

Condition Code 62 on the UB-04 claim form is defined as “PIP bill not reported by providers” according to the Noridian Medicare condition code list. ^[1] This code is classified as a payer-only code, meaning it is used by Medicare or other payers to indicate that the provider did not submit a Partial Interim Payment (PIP) bill for the episode of care. In the Noridian list, code 62 appears immediately after code 61 (“Operating cost outlier not reported by providers”) and before code 63 (“Bypass CWF edit for incarcerated beneficiaries”). ^[1] Providers themselves generally do not enter this code; it is typically appended by the payer during claims processing to flag the absence of a PIP billing record. The code helps ensure that payment adjustments related to interim payments are properly tracked and reconciled. While the MassHealth UB-04 guide does not specifically reference code 62, the Noridian source serves as the authoritative reference for Medicare Part A condition codes. ^[2]

When to Use

Condition Code 62 should be applied only by the payer, not by the provider, to indicate that the provider did not report a PIP bill for the service period. ^[1] This code is relevant in Medicare Part A claims processing when the provider has either submitted a final bill without having previously reported a PIP bill, or when the PIP billing record is missing from the system. The code is part of a set of payer-only condition codes that include code 60 (“Operating cost day outlier”), code 61 (“Operating cost outlier not reported by provider”), and code 15 (“Clean claim delayed in CMS processing system”). ^[1] Providers should be aware that if they fail to submit a PIP bill when required, the payer may subsequently add code 62 to the claim record. However, providers should not manually enter this code on the UB-04 form. Instead, they should ensure that PIP bills are submitted as appropriate to avoid the need for this code. The Noridian list does not provide further context on specific situations requiring code 62 beyond the definition. ^[1]

Step-by-Step Claim Example

Consider a hospital that provides inpatient services to a Medicare beneficiary and is eligible for PIP (Partial Interim Payment). The hospital is expected to submit a PIP bill before the final claim. However, due to administrative oversight, the hospital does not report a PIP bill and later submits only the final claim for the inpatient stay. When the Medicare contractor processes the final claim, they detect that no PIP bill was reported for that admission. The payer then adds Condition Code 62 (“PIP bill not reported by providers”) to the claim record. ^[1] The claim is processed with this code to flag the missing interim billing. The remittance advice may show an adjustment to account for the fact that no partial payment was previously issued. The hospital receives the final payment less any PIP amount that would have been paid earlier. This example illustrates the operational use of code 62 by the payer, not the provider, to maintain accurate payment tracking.

Common Mistakes & Audit Red Flags

A common mistake is for providers to mistakenly enter Condition Code 62 themselves on the UB-04. Per the Noridian list, this code is designated as a “Payer Only Code” and should not be used by billing entities. ^[1] If a provider incorrectly includes code 62, the claim may be rejected or cause processing delays. Another mistake is failing to submit a required PIP bill, which then prompts the payer to add code 62. This can trigger an audit because the missing interim payment may indicate a pattern of billing noncompliance. Additionally, using code 62 in conjunction with other condition codes that relate to outlier payments (e.g., code 61) may draw scrutiny from the Medicare administrative contractor. The Noridian list does not specify audit triggers, but any payer-only code appearing on a provider-submitted claim is a red flag for potential fraud or error. Providers should review their billing practices to ensure PIP bills are submitted on time to avoid the addition of code 62 to their claims.

Related Codes/Fields

Code	Meaning	Source
60	Operating cost day outlier (Payer only code)	[1]
61	Operating cost outlier not reported by provider	[1]
62	PIP bill not reported by providers (Payer only code)	[1]
63	Bypass CWF edit for incarcerated beneficiaries	[1]
64	Other than clean claim	[1]
65	Non-PPS bill not reported by providers	[1]

These codes are all part of the same Noridian condition code list and are frequently used in the context of Medicare Part A billing adjustments and payer-only notations. ^[1] Providers should be familiar with codes 60-65 as they relate to outlier and interim payment reporting.

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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