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Overview
Condition codes on the UB-04 claim form provide supplementary information about the patient’s condition, coverage, or billing circumstances. The Noridian Medicare source lists a range of numeric condition codes (01 through 77) with corresponding descriptions, but does not include an alphanumeric code “C1” in the extracted code‑to‑description mapping. [1] The MassHealth UB-04 guide does not discuss specific condition codes and focuses on general claim submission instructions. [2] Therefore, based solely on the provided sources, no description, usage, or context is available for code C1.
When to Use
The provided sources do not contain any information that defines when condition code C1 should be used. The Noridian list includes code 30 (“Non‑research services provided to all patients enrolled in a Qualified Clinical Trial”), which is conceptually related to clinical trial billing, but it is not the same as code C1. [1] Without explicit source material describing C1, it is not possible to specify the appropriate circumstances for its application. Providers should refer to the official Medicare condition code list or their MAC’s guidance for any code not present in the supplied extracts.
Step-by-Step Claim Example
No step‑by‑step claim example can be constructed for code C1 because the provided sources do not include any examples, definitions, or billing instructions for this code. The Noridian page offers examples for other codes (e.g., code 30 for clinical trial patients) but none for C1. [1] The MassHealth guide contains no condition code examples at all. [2] Until the missing code description is obtained from an authoritative source, a valid example cannot be provided.
Common Mistakes & Audit Red Flags
Because no authoritative description for code C1 exists in the supplied sources, common mistakes and audit red flags cannot be identified. In general, incorrect or missing condition codes can lead to claim denials or delays. Providers should always verify that condition codes are supported by their payer’s published list and should never use a code without a clear definition. Without source‑specific information for C1, any claims submitted with this code risk being rejected unless the payer explicitly accepts it.
Related Codes/Fields
The table below lists condition codes from the Noridian source that relate to clinical trials or research, as they are the closest context to the unverified C1 code.
| Code | Meaning | Source |
|---|---|---|
| 30 | Non‑research services provided to all patients enrolled in a Qualified Clinical Trial | [1] |
| 53 | Initial placement of medical device as part of clinical trial or free sample | [1] |
| C1 | Not provided in supplied sources | — |
No other UB-04 fields (e.g., value codes, occurrence codes) are mentioned in the provided sources as directly associated with condition code C1. For complete field relationships, consult the official NUBC manual or your Medicare administrative contractor. ---END---
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
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Last Updated: 2026-05-29
Sources: CMS Pub. 100-04 Chapter 25, NUBC Official UB-04 Manual, Medicare Contractor Bulletins (Noridian, Palmetto, CGS)