UB04 Condition Codes Code 74: Home

Overview

Condition Code 74 is a UB-04 condition code with the meaning “Billing is for a patient who received dialysis services at home.” ^[1] This code is part of a larger set of condition codes used by institutional providers to convey special circumstances about a claim. Specifically, code 74 identifies that the dialysis services being billed were furnished in the patient’s home rather than in a dialysis facility or hospital-based unit. According to the Noridian list, code 74 is one of several codes related to dialysis services, including codes 70 (self-administered EPO for home dialysis), 71 (full care in unit), 72 (self-care in unit), 73 (self-care training), 75 (home dialysis with machine purchased under 100% payment program), and 76 (back-up dialysis in-facility). ^[1] The UB-04 claim form itself is used by institutional providers such as acute inpatient and outpatient hospitals, as noted in the MassHealth UB-04 Billing Guide. ^[2] However, the specific application of condition code 74 is defined solely by the Noridian source.

When to Use

Condition Code 74 should be used when a provider bills for dialysis services that were delivered to a patient in their home. ^[1] It is important to note that code 74 is specifically for the dialysis service itself; other home health services, such as skilled nursing or home health aide visits, would not warrant this code unless they are directly related to the home dialysis treatment. Using code 74 correctly signals to the payer that the services were rendered in the home environment, which may affect medical review and audit focus.

Step-by-Step Claim Example

Consider a Medicare patient who receives home hemodialysis three times per week. The dialysis provider, a hospital-based home dialysis program, submits a UB-04 claim for the services provided during a calendar month. On the UB-04 claim form, the provider enters Condition Code 74 in the appropriate condition code field to indicate that the billing is for a patient who received dialysis services at home. ^[1] The provider also includes other relevant condition codes if applicable. For instance, if the patient self-administers EPO at home, the provider may also report Condition Code 70. ^[1] The claim includes revenue codes for home dialysis (e.g., revenue code 0820 for home dialysis) and appropriate HCPCS codes for the dialysis treatment and supplies. The provider ensures that the condition code is placed in the correct location on the form, typically in fields 18–28 of the UB-04, as these fields are designated for condition codes. The MassHealth UB-04 Billing Guide provides general instructions for completing the form, including the use of code sets, but does not specify field numbers for condition codes. ^[2] After submission, the payer processes the claim using the condition code to apply home dialysis-specific coverage rules, such as verifying that the patient meets criteria for home dialysis and that the services are not duplicated with in-facility dialysis. The claim example demonstrates how code 74 functions as a critical identifier for home dialysis billing.

Common Mistakes & Audit Red Flags

One common mistake is using Condition Code 74 for home health services that are not dialysis-related. The code is explicitly defined as “Billing is for a patient who received dialysis services at home.” ^[1] Applying it to other types of home care, such as home infusion therapy or home health aide visits, would be incorrect and could lead to claim denials or overpayments. Another error is failing to report code 74 when billing for home dialysis, which may cause the payer to process the claim under in-facility rules, potentially resulting in lower reimbursement or additional documentation requests. Providers should also avoid using code 74 for dialysis services that were actually performed in a facility, such as a hospital outpatient dialysis unit or a freestanding dialysis center. Audit red flags include inconsistent use of code 74 across claims for the same patient, or using code 74 alongside codes that contradict home dialysis (e.g., code 71 for full care in unit). ^[1] Payers may review claims with code 74 to ensure that the patient’s medical records support home dialysis, including a home assessment, training documentation, and a plan of care. Additionally, if code 74 is used but the claim also includes revenue codes for facility dialysis, auditors may question the accuracy of the condition code. Providers should maintain clear documentation of the home dialysis setting to support the use of code 74. The MassHealth UB-04 Billing Guide emphasizes the importance of accurate claim completion, though it does not specifically address condition code 74. ^[2]

Related Codes/Fields

The following table lists condition codes from the Noridian source that are directly related to home dialysis or dialysis services. These codes may be used in conjunction with code 74 on the UB-04 claim form.

Code	Meaning	Source
70	Self-administered EPO (home dialysis)	[1]
71	Full care in unit (dialysis)	[1]
72	Self-Care in unit (dialysis)	[1]
73	Self-Care training (dialysis)	[1]
74	Billing is for a patient who received dialysis services at home	[1]
75	Billing for home dialysis with machine purchased under 100% payment program	[1]
76	Back-up dialysis in-facility	[1]

These condition codes are part of the UB-04 code set and are typically entered in the condition code fields (e.g., fields 18–28) on the claim form. The MassHealth UB-04 Billing Guide provides general instructions for completing the form but does not list these specific codes. ^[2] Providers should refer to the Noridian source for the most current and complete list of condition codes.

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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