UB04 Type of Bill Code 0133: Hospital Outpatient - Interim - Continuing Claim

Overview

Type of Bill (TOB) Code 0133 is a four-digit alphanumeric code used on the UB-04 claim form to identify a specific billing scenario. The leading zero is ignored by CMS and provides no billing information. The second digit "1" indicates the type of facility is a Hospital. The third digit "3" indicates the type of care is Outpatient. The fourth digit "3" indicates the frequency is Interim - Continuing Claims. ^[1]

This code is used when a hospital has already submitted an interim first claim (TOB 0132) for an ongoing outpatient episode of care and is now submitting a subsequent claim for additional services provided during that same episode. The "Continuing Claims" frequency means this is not the first claim and not the last claim for the episode. ^[1]

While MassHealth has adopted an all-electronic claims submission policy effective January 1, 2012, providers with approved electronic claim submission waivers may still submit paper UB-04 claims. ^[2]

When to Use

Use TOB 0133 when you are a Hospital providing Outpatient services and need to submit an Interim - Continuing Claim for an ongoing episode of care. This typically occurs in the following scenarios:

• Long-term outpatient treatment: When a patient requires multiple outpatient visits over an extended period (e.g., chemotherapy, radiation therapy, dialysis, or rehabilitation) and the provider bills in segments rather than waiting for the entire course of treatment to complete.
• Split billing for high-cost services: When the total charges for an outpatient episode exceed payer thresholds requiring interim billing to manage cash flow.
• Continuing care after initial interim claim: After submitting TOB 0132 (Interim - First Claim), subsequent claims for the same episode use TOB 0133 until the final claim (TOB 0134) is submitted.
• ^[2]

The code is not used for:

• Inpatient services (use 011x series)
• Outpatient services that are complete (use 0131 for admit through discharge)
• The first interim claim (use 0132)
• The last interim claim (use 0134)
• Late charges only (use 0135)

Step-by-Step Claim Example

Scenario: A hospital outpatient department is treating a patient for a series of 12 chemotherapy sessions over 6 weeks. The hospital bills in three segments: first claim (sessions 1-4), continuing claim (sessions 5-8), and final claim (sessions 9-12).

Step 1: Verify patient eligibility and authorization

• Confirm the patient's insurance coverage for outpatient chemotherapy
• Obtain any required prior authorization for the treatment plan

Step 2: Complete the UB-04 claim form header

• Field 1: Provider name, address, and NPI
• Field 2: Pay-to name and address (if different)
• Field 3: Patient control number (e.g., "CHEMO-2024-001")
• Field 4: 0133 (Type of Bill)
• Field 5: Federal tax number
• Field 6: Statement covers period (e.g., "02012024" to "02142024" for sessions 5-8)

Step 3: Complete patient and payer information

• Field 8a-8c: Patient name, address, and ID number
• Field 50: Payer identification (primary, secondary, tertiary)
• Field 51: Health plan ID
• Field 52: Release of information certification
• Field 53: Assignment of benefits certification

Step 4: Enter service line details

• Field 43: Revenue description
• Field 45: Service date (e.g., "02052024" through "02142024")
• Field 46: Service units (e.g., "4" for four sessions)
• Field 47: Total charges ($12,000 for sessions 5-8)
• Field 48: Non-covered charges ($0)
• Field 49: Payer-related adjustments

Step 5: Complete the claim

• Field 56: Procedure codes (if applicable)
• Field 57: Other provider IDs
• Field 58: Insured's name
• Field 59: Patient relationship
• Field 60: Insurance group number
• Field 61: Insurance group name
• Field 62: Employment status
• Field 63: Treatment authorization code
• Field 64: Document control number (reference to prior claim)
• Field 66: Diagnosis code pointer
• Field 67: Present on admission indicator
• Field 68: Other procedure date
• Field 71: DRG code (not applicable for outpatient)
• Field 72: ECI code
• Field 76: Attending provider NPI
• Field 77: Operating provider NPI
• Field 78-79: Other provider NPIs
• Field 80: Remarks (e.g., "Continuing claim for chemotherapy series")
• Field 81: Code-Code (CCL/CCN)

Step 6: Submit the claim

• For paper: Mail to appropriate MassHealth address (if waiver approved)
• For electronic: Submit via POSC or clearinghouse

Common Mistakes & Audit Red Flags

1. Using 0133 for the first interim claim: The first interim claim must use 0132 (Interim - First Claim), not 0133. Using 0133 for the first claim will result in rejection. ^[1]

2. Using 0133 for a complete episode: If the outpatient services are complete and you are billing the entire episode at once, use 0131 (Admit Through Discharge), not 0133.

3. Missing reference to prior claim: When submitting a continuing claim, ensure Field 64 (Document Control Number) contains the ICN/DCN from the previous interim claim (0132) to establish the claim chain.

4. Incorrect statement covers period: The dates in Field 6 must reflect only the services in this continuing claim, not the entire episode. For example, if the episode spans January 1 to February 28, and this is the second interim claim covering February 1-14, the dates should be "02012024" to "02142024".

5. Duplicate billing: Ensure services billed on the continuing claim are not also billed on the first interim claim (0132) or the final claim (0134). Each claim should cover distinct, non-overlapping service dates.

6. Missing prior authorization: Some outpatient services (e.g., chemotherapy, radiation) require prior authorization. Submitting a continuing claim without the authorization code in Field 63 will cause denial.

7. Incorrect revenue codes: Outpatient services require specific revenue codes (e.g., 0450 for ER, 0510 for clinic, 0260 for chemotherapy). Using inpatient revenue codes (e.g., 0100-0199) will cause rejection.

8. Using 0133 for non-hospital facilities: This code is only for hospitals. Skilled nursing facilities use 02xx, home health uses 03xx, etc. ^[1]

9. Missing the leading zero: While CMS ignores the leading zero, the UB-04 format requires it. Entering "133" instead of "0133" will cause the claim to be rejected.

10. Using 0133 for inpatient services: Inpatient interim continuing claims use 0113, not 0133. The third digit "1" indicates inpatient; "3" indicates outpatient. ^[1]

Related Codes/Fields

Code/Field	Description	Relationship to 0133
0131	Hospital Outpatient - Admit Through Discharge	Use for complete outpatient episodes; 0133 is for continuing claims within an episode
0132	Hospital Outpatient - Interim - First Claim	Precedes 0133; the first interim claim in a series
0134	Hospital Outpatient - Interim - Last Claim	Follows 0133; the final claim in the series
0135	Hospital Outpatient - Late Charge Only	Use for late charges after final claim; not for continuing services
0113	Hospital Inpatient - Interim - Continuing Claims	Same frequency but for inpatient services (different type of care)
0123	SNF Outpatient - Interim - Continuing Claims	Same frequency but for skilled nursing facility outpatient
0130	Hospital Outpatient - Non-payment/Zero Claim	Use for zero-payment claims; not for continuing services
Field 4	Type of Bill	The field where 0133 is entered on the UB-04
Field 6	Statement Covers Period	Must reflect dates of service for this continuing claim only
Field 64	Document Control Number	Must reference the prior interim claim (0132) ICN
Field 63	Treatment Authorization Code	Required for services needing prior authorization
Field 42	Revenue Codes	Must be outpatient-appropriate (e.g., 0450, 0510, 0260)

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References

[1] Noridian Bill Types — https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download