UB04 Condition Codes Code 78: New Technology Add-on Payment

Overview

The condition code signals to the payer that the provider is requesting the add-on payment for a qualifying technology. ^[1]

The UB-04 form is used by institutional providers (e.g., hospitals) to submit claims to Medicare and other payers. ^[2]

Providers must ensure that the technology for which NTAP is claimed has been approved by the Centers for Medicare & Medicaid Services (CMS) for the applicable fiscal year. The condition code must be present on the claim for the add-on payment to be considered. Without Code 78, the claim may be processed without the additional payment. ^[1]

When to Use

Use Condition Code 78 when submitting an inpatient hospital claim that includes a CMS-approved new technology for which the provider is requesting the New Technology Add-on Payment. This code applies only to Medicare Part A IPPS claims. It is not used for outpatient, skilled nursing facility, or other claim types. ^[1]

The technology must be separately identified on the claim using the appropriate revenue code and HCPCS code (if applicable). ^[2]

Examples of situations requiring Code 78:

• A hospital implants a new FDA-approved cardiac device that qualifies for NTAP in the current fiscal year.
• A hospital administers a new antimicrobial drug that meets CMS criteria for NTAP.
• A hospital uses a new surgical system that has been granted NTAP status.

Providers should verify the current list of NTAP-eligible technologies on the CMS website before submitting claims. ^[1]

Step-by-Step Claim Example

Scenario: A Medicare beneficiary is admitted for a total hip replacement using a new robotic‑assisted surgical system that qualifies for NTAP. The hospital submits a UB‑04 claim.

1. Complete header information: Enter patient name, Medicare number, admission/discharge dates, and provider information.
2. Revenue code: Use revenue code 0360 (Operating Room Services) or a specific code for the technology, as required by CMS.
3. HCPCS code: If applicable, enter the HCPCS code for the new technology (e.g., C‑code for NTAP devices).
4. Condition code: In one of the condition code fields (e.g., field 18), enter 78.
5. Other condition codes: Do not enter codes that contradict NTAP (e.g., code 77 for provider accepts primary payment as payment in full).
6. Submit claim: Send to Medicare administrative contractor (MAC) for processing.

The MAC will identify Code 78 and, if the technology is on the approved NTAP list, add the appropriate payment amount to the DRG payment. ^[1]

Common Mistakes & Audit Red Flags

• Missing Condition Code 78: The most frequent error is omitting the code, causing the NTAP to be denied. Always double‑check that Code 78 is present when a new technology is billed.
• Using code 78 for non‑qualifying technologies: Do not use Code 78 for technologies that have not received CMS NTAP approval. This can lead to claim denials and potential audits.
• Conflicting condition codes: Avoid using codes that indicate the provider accepts the primary payer’s payment as payment in full (e.g., code 77) alongside Code 78, as this may cancel the NTAP request.
• Incorrect revenue or HCPCS codes: The new technology must be reported with the correct revenue code and HCPCS code. Mismatched codes can result in the NTAP not being recognized.
• Outdated NTAP list: CMS updates the list of eligible technologies annually. Using Code 78 for a technology that is no longer on the list will cause denial. ^[1]

Auditors look for consistency between the condition code, revenue code, and HCPCS code. Any discrepancy may trigger a review. Providers should maintain documentation proving the technology’s NTAP eligibility. ^[2]

Related Codes/Fields

Code/Field	Description	Relationship to Code 78
Condition Code 77	Provider accepts primary payer payment as payment in full	Should not be used with Code 78; may override NTAP request
Revenue Code 0360	Operating Room Services	Commonly used for surgical NTAP technologies
Revenue Code 0270	Medical/Surgical Supplies and Devices	Used for implantable devices eligible for NTAP
HCPCS C‑codes	Temporary codes for new technology (e.g., C‑xxxx)	Required to identify the specific NTAP technology
Field 18–28	Condition code fields on UB‑04	Where Code 78 must be entered
DRG Payment	Diagnosis‑Related Group base payment	NTAP is an add‑on to the DRG payment

^[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