UB04 Condition Codes Code 75: Home - Hospital Satellite

Overview

Condition Code 75, "Home - Hospital Satellite," is used on the UB-04 claim form to indicate billing for home dialysis services where the patient has purchased a dialysis machine under a 100% payment program. This code specifically applies to patients who receive dialysis services at home and have acquired their dialysis machine through a program that covers the full cost of the equipment. ^[1]

The code is part of a series of dialysis-related condition codes (70-77) that help payers distinguish between different dialysis settings and equipment arrangements. Code 75 is distinct from Code 74 ("Billing is for a patient who received dialysis services at home") because it specifically addresses the machine purchase arrangement rather than just the location of service delivery. ^[1]

This condition code is primarily used by Medicare Part A providers and suppliers who bill for home dialysis services. It ensures proper payment calculation and prevents duplicate billing for equipment that has already been fully reimbursed through a separate program. The code helps Medicare and other payers identify claims where the dialysis machine was acquired through a 100% payment program, which affects how the dialysis services themselves should be reimbursed. ^[1]

MassHealth providers should note that while this code is listed in national code sets, its specific application may vary by state Medicaid program. Providers should verify with their specific payer whether Code 75 is recognized and how it affects reimbursement for home dialysis services. ^[2]

When to Use

Condition Code 75 should be used when billing for home dialysis services provided to a patient who has purchased their dialysis machine through a 100% payment program. This typically applies to Medicare beneficiaries who have obtained a home dialysis machine under Medicare's special payment provisions that cover the full cost of the equipment. ^[1]

The code is appropriate in the following scenarios:

• The patient is receiving dialysis at home
• The dialysis machine was purchased under a program that pays 100% of the equipment cost
• The claim is for dialysis services only, not for the machine itself
• The provider is billing for supplies, training, or support services related to home dialysis ^[1]

Providers should NOT use Code 75 when:

• The patient is using a rented dialysis machine (use Code 74 instead)
• The patient is receiving dialysis in a facility setting (use Codes 71-73)
• The patient is self-administering EPO at home (use Code 70)
• The patient requires backup dialysis in a facility (use Code 76) ^[1]

This code is typically entered in Form Locator 18-28 on the UB-04 claim form, which accommodates up to 12 condition codes. When multiple condition codes apply, Code 75 should be listed along with any other relevant codes that describe the patient's situation. ^[2]

Step-by-Step Claim Example

Scenario: A Medicare beneficiary named John has end-stage renal disease (ESRD) and performs home dialysis using a machine he purchased through Medicare's 100% payment program. His home dialysis provider is billing for monthly supplies and support services.

Step 1: Identify the appropriate condition code. Since John purchased his dialysis machine under a 100% payment program and receives dialysis at home, Condition Code 75 is applicable. ^[1]

Step 2: Complete Form Locator 18-28 (Condition Codes). Enter "75" in one of the available condition code fields on the UB-04 form. If other condition codes apply (e.g., Code 06 for ESRD patient in first 30 months of entitlement), list them in priority order. ^[2]

Step 3: Complete Form Locator 8 (Patient Name). Enter John's full legal name as it appears on his Medicare card.

Step 4: Complete Form Locator 10 (Birth Date and Sex). Enter John's date of birth and sex.

Step 5: Complete Form Locator 11-17 (Patient Address and Insurance Information). Enter John's home address (since dialysis is performed at home) and his Medicare information.

Step 6: Complete Form Locator 42 (Revenue Codes). Enter the appropriate revenue codes for home dialysis supplies and services (e.g., 0820 for home dialysis supplies, 0830 for home dialysis support services).

Step 7: Complete Form Locator 44 (HCPCS/Rates). Enter the appropriate HCPCS codes for the specific supplies and services provided.

Step 8: Complete Form Locator 46 (Service Units). Enter the number of units for each service line.

Step 9: Complete Form Locator 47 (Total Charges). Enter the total charges for all services.

Step 10: Complete Form Locator 50 (Payer Identification). Enter Medicare as the primary payer.

Step 11: Review and submit. Verify that Condition Code 75 is correctly entered and that all other fields are complete and accurate before submitting the claim.

Common Mistakes & Audit Red Flags

Mistake 1: Using Code 75 when the machine is rented. If the patient is renting the dialysis machine rather than purchasing it under a 100% payment program, Code 74 ("Billing is for a patient who received dialysis services at home") should be used instead. Using Code 75 incorrectly can result in claim denials or overpayments. ^[1]

Mistake 2: Failing to include supporting documentation. When billing with Code 75, providers should maintain documentation proving the patient purchased the machine under a 100% payment program. Auditors may request this documentation to verify the condition code's accuracy.

Mistake 3: Using Code 75 for facility-based dialysis. This code is specifically for home dialysis services. If the patient receives dialysis in a hospital or dialysis center, use Codes 71 (full care in unit), 72 (self-care in unit), or 73 (self-care training) instead. ^[1]

Mistake 4: Combining Code 75 with incompatible codes. Code 75 should not be used simultaneously with codes that indicate facility-based dialysis (71-73) or backup dialysis (76) unless the patient's situation genuinely involves multiple settings. Inconsistent condition codes can trigger audit flags.

Audit Red Flags:

• Claims with Code 75 but no corresponding home dialysis revenue codes (0820-0839)
• Claims showing Code 75 for patients who also have facility dialysis claims on the same date
• Frequent use of Code 75 without supporting equipment purchase documentation
• Claims where Code 75 is the only condition code but the patient has other relevant conditions (e.g., ESRD status) that should also be coded

Related Codes/Fields

Code/Field	Description	Relationship to Code 75
Code 70	Self-administered EPO (home dialysis)	Related home dialysis code for EPO administration
Code 71	Full care in unit (dialysis)	Facility-based dialysis, mutually exclusive with Code 75
Code 72	Self-Care in unit (dialysis)	Facility-based dialysis, mutually exclusive with Code 75
Code 73	Self-Care training (dialysis)	Training for home dialysis, may precede Code 75
Code 74	Billing for patient who received dialysis services at home	Similar to Code 75 but for rented machines
Code 76	Back-up dialysis in-facility	May be used alongside Code 75 for backup services
Code 77	Provider accepts primary payer payment as payment in full	Payment acceptance code, may appear with Code 75
Code 06	ESRD patient in first 30 months of entitlement	Often used with Code 75 for ESRD patients
Form Locator 42	Revenue Codes (0820-0839 for home dialysis)	Required to specify home dialysis services
Form Locator 44	HCPCS Codes	Required to identify specific dialysis supplies/services

^[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