UB04 Condition Codes Code D2: Changes in Revenue Codes/HCPCS

Overview

Condition codes on the UB-04 claim form are used to convey special circumstances about a patient’s episode of care or billing situation. The Noridian Condition Codes list (JE Part A) includes numeric codes from 01 to 77, each with a specific definition such as “Military service related” (01) or “ESRD patient in the first 30 months of entitlement covered by employer group health insurance” (06). ^[1]

The code D2 is not present in the extracted Noridian mapping. The MassHealth UB-04 Billing Guide references condition codes as part of the “Code Sets for the UB-04 Claim Form” section but does not list a D2 code in the provided excerpt. ^[2]

Because neither source contains code D2, this article focuses on general condition‑code usage and the fields where such codes are placed. For payer‑specific codes like D2, providers should consult their individual payer’s claim‑submission instructions or the complete Noridian condition‑code table.

When to Use

Condition codes are entered in Field 18–28 of the UB-04 form, which contains two‑character code positions. According to the Noridian list, codes are typically numeric (e.g., 15 for “Clean claim delayed in CMS processing system”). ^[1]

The exact timing and payer‑specific rules for D2 must be obtained directly from the payer, as it is not documented in the provided sources.

Step-by-Step Claim Example

Because D2 is absent from the sources, the example below uses a standard numeric code (04 – informational bill) to illustrate condition‑code placement.

1. Identify the need for a condition code. The provider is submitting a no‑pay informational bill.
2. Locate Field 18–28 on the UB-04 form. Positions are labeled “COND” with two‑character slots.
3. Enter the appropriate code. In this case, place “04” in the first position.
4. Complete remaining fields as usual (e.g., revenue codes, HCPCS, patient demographics).
5. Review the MassHealth billing guide for any payer‑specific instructions. ^[2]

For code D2, the same placement would apply, but the provider must confirm with their payer that “D2” is a valid code and what change(s) it represents (e.g., revised revenue codes or HCPCS from a previously submitted claim).

Common Mistakes & Audit Red Flags

• Using a code not recognized by the payer. Since D2 does not appear in the Noridian or MassHealth-provided lists, submitting it without payer confirmation may cause the claim to be rejected.
• Incorrect code sequence. Condition codes must be entered left‑to‑right in Field 18–28. For example, code 04 should be entered in the first position, not the second.
• Missing supporting documentation. If a condition code implies a specific circumstance (e.g., code 03 – other insurance), the claim must include corresponding third‑party liability information as described in MassHealth’s appendix. ^[2]
• Using numeric codes not in the standard set. The Noridian list shows codes 01–77; any other numeric code may be payer‑specific and require verification.

Audit red flags arise when a condition code contradicts other data on the claim (e.g., code 02 for workers’ compensation but the patient’s insurance indicates Medicare only). MassHealth’s billing guide stresses consistent data across the form. ^[2]

Related Codes/Fields

Field / Code	Description	Source
Condition Codes	Filed in positions 18–28 (two‑character alphanumeric codes)	[2]
Revenue Codes	Entered in Field 42 to identify the type of service or accommodation	[2]
HCPCS Codes	Entered in Field 44 for procedures and services	[2]
Code 15 (Noridian)	“Clean claim delayed in CMS processing system” (payer only code)	[1]
Code 04 (Noridian)	“Bill is submitted for informational purposes only”	[1]

Note: The provided sources do not list code D2. For any condition code not found in these references, consult the payer’s full condition‑code table or official CMS documentation.

---

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