UB04 Condition Codes Code 68: Other Waiting Period

Overview

Code 68, "Other Waiting Period," is a UB-04 Condition Code used to indicate that a beneficiary has elected to use Lifetime Reserve (LTR) days during a hospital stay. This code is specifically listed as "Beneficiary elects to use LTR days" in the Noridian Condition Codes reference. ^[1]

Condition Codes are two-digit numeric or alphanumeric codes entered in Form Locators 18-28 of the UB-04 claim form. These codes communicate special conditions or circumstances affecting the claim, such as patient election of benefit options, coordination of benefits, or other payer-specific requirements. Code 68 specifically addresses the beneficiary's voluntary decision to apply their limited lifetime reserve days (up to 60 days per lifetime) to a Medicare-covered inpatient stay. ^[2]

The code serves an important administrative function by documenting that the patient is aware that using LTR days reduces their lifetime pool of available reserve days. It differs from Code 67 ("Beneficiary elects not to use LTR days") which indicates the opposite election. Proper use of this code ensures accurate benefit utilization tracking and payment calculation by Medicare Administrative Contractors (MACs). ^[1]

When to Use

Use Code 68 when a Medicare beneficiary has been informed of their remaining Lifetime Reserve (LTR) days and voluntarily elects to apply these days to their current inpatient stay. This typically occurs when a patient has exhausted their 90-day benefit period coverage for the current spell of illness and chooses to access their limited pool of 60 lifetime reserve days to continue coverage. ^[1]

The code should not be used for patients who decline LTR days (use Code 67 instead) or for patients who have no remaining LTR days available. It is also not appropriate for patients in a benefit period where standard coverage still applies. Providers should only apply this code after obtaining written documentation of the beneficiary's election, as the decision is irrevocable once made. ^[1]

This code is particularly relevant for:

• Patients with extended hospital stays beyond 90 days in a benefit period
• Patients who have been informed of their remaining LTR day balance (which varies per individual)
• Claims where the hospital is billing Medicare Part A and the patient has requested continued coverage
• Situations where the patient has no other insurance that would cover the days beyond the 90-day limit

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Step-by-Step Claim Example

Scenario: Medicare beneficiary John Smith is admitted to City General Hospital on January 15 for a complicated pneumonia. By April 10, he has been in the hospital for 92 days in the current benefit period. The hospital notifies him that he has used all 90 standard benefit period days and has 2 days remaining in his 60-day LTR pool. He elects to use LTR days.

Step 1: Obtain Beneficiary Election – The hospital explains that using LTR days will reduce his lifetime pool from 60 to 58 days remaining. Mr. Smith signs an election form. ^[1]

Step 2: Identify Form Locators – On the UB-04 claim, locate Form Locator 18 (first position) through Form Locator 28 (last position). The claim already contains Condition Code 01 for military service coordination from a prior VA-related issue. ^[2]

Step 3: Enter Code 68 – In the next available position in Form Locators 18-28, enter "68" to indicate the beneficiary's election to use LTR days. The completed field might show: "01 68" if only one other code exists. ^[1]

Step 4: Complete Remaining Claim Fields – Ensure other required fields are accurate, including patient name, Medicare HIC number, dates of service (April 10 for the LTR day usage), revenue codes, and charges.

Step 5: Submit Claim – The provider submits the UB-04 with Code 68 and other required information. The Medicare Administrative Contractor (MAC) processes the claim, reducing Mr. Smith's LTR balance by 2 days. ^[1]

Common Mistakes & Audit Red Flags

Common Mistakes:

• Using Code 68 when the patient did not explicitly elect LTR days (always require written documentation)
• Failing to verify remaining LTR balance before applying the code (can lead to claim denials)
• Using Code 68 interchangeably with Code 67 (indicates opposite election)
• Applying the code to outpatient claims or claims not involving Medicare Part A coverage
• Entering Code 68 in incorrect positions (should be in Form Locators 18-28, not elsewhere on the form)

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Audit Red Flags:

• Claims with Code 68 but no corresponding documentation of beneficiary election (CMS auditors will request signed forms)
• Inconsistent coding where Code 68 appears alongside codes suggesting the patient is not using LTR days (e.g., Code 67 on same claim)
• Claims showing Code 68 for patients with fewer than 5 LTR days remaining (high risk of exhaustion disputes)
• Repeated use of Code 68 on consecutive claims for the same patient without verifying remaining balance
• Claims where Code 68 is used but revenue centers do not reflect inpatient days beyond the 90-day benefit period

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Related Codes/Fields

Code/Field	Description	Relationship to Code 68
Code 67	Beneficiary elects NOT to use LTR days	Direct opposite; use instead of Code 68 when patient declines LTR days
Code 01	Military service related; coordinate with VA	May appear on same claim if patient has VA eligibility
Code 02	Employment/environmental injury (workers comp)	Co-occurrence possible when LTR days used during injury-related stay
Code 06	ESRD patient in first 30 months (EGHP)	May affect whether LTR days are needed due to primary payer
Code 63	Bypass CWF edit for incarcerated beneficiaries	Different circumstance but affects LTR day calculation if applicable
Form Locator 72 (Revenue Code)	Inpatient Days	Should show days beyond 90 to justify LTR need
Form Locator 67 (Value Codes)	Lifetime Reserve Days Used	May appear to document actual LTR day count
Form Locator 56 (NPI)	Provider identification	Required for proper LTR tracking
Code 28	Patient/spouse EGHP secondary to Medicare	May reduce LTR day need if primary payer covers beyond 90 days

^[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