UB04 Type of Bill Code 0134: Hospital Outpatient - Interim - Last Claim

Overview

The UB-04 Type of Bill code 0134 represents a claim from a Hospital Outpatient facility that is an Interim - Last Claim. This code is part of the standardized four-digit alphanumeric system used for Medicare and other payer billing. The structure breaks down as follows: the leading zero is ignored by CMS, the second digit "1" indicates a hospital facility, the third digit "3" signifies outpatient care, and the fourth digit "4" denotes the frequency as an interim last claim. ^[1]

This code is specifically used when a hospital outpatient department has been billing interim claims (codes 0132 or 0133) for an ongoing episode of care and is now submitting the final claim to close out that episode. The "interim last claim" designation signals to the payer that no further claims will be submitted for this particular outpatient encounter or treatment period. ^[1]

MassHealth providers must use the UB-04 claim form when submitting paper claims for acute outpatient hospitals, including hospital-licensed health centers and other hospital satellite facilities. However, effective January 1, 2012, MassHealth adopted an all-electronic claims submission policy, requiring all claims to be submitted electronically unless the provider has received an approved electronic claim submission waiver. ^[2]

When to Use

Use Type of Bill code 0134 when your hospital outpatient department has been billing interim claims (0132 for first interim or 0133 for continuing interim claims) for a patient's ongoing outpatient treatment and you are now ready to submit the final claim that closes out that episode of care. This typically occurs when the patient's course of outpatient treatment has been completed, the patient has been discharged from the outpatient program, or the billing period has ended and no further services will be provided under that specific encounter. ^[1]

This code is appropriate for hospital outpatient departments providing services such as outpatient surgery, observation services, emergency department visits, outpatient therapy, diagnostic testing, or other hospital-based outpatient care that spans multiple billing periods. The interim billing approach allows providers to receive partial payments during an extended course of treatment, with the 0134 code serving as the final reconciliation claim. ^[1]

Do not use this code for inpatient services (which would use 011X codes), skilled nursing facility services (021X), or for outpatient services that are being billed as a single claim from admission through discharge (which would use 0131). Also avoid using this code if you are submitting a late charge only (0135), a replacement claim (0137), or a void/cancel claim (0138). ^[1]

Step-by-Step Claim Example

Scenario: A patient receives outpatient physical therapy at a hospital outpatient department over a six-week period. The provider bills interim claims (0133) for weeks 1-5 and now submits the final claim for week 6 using code 0134.

Step 1: Verify the patient's eligibility and obtain any required prior authorization for the outpatient therapy services. Ensure the patient's insurance is active and covers the specific outpatient services being provided. ^[2]

Step 2: Complete the UB-04 claim form header information, including the provider's name, address, National Provider Identifier (NPI), and Medicare number. Enter the patient's demographic information including name, date of birth, gender, and insurance identification number in the appropriate fields. ^[2]

Step 3: In Field 4 (Type of Bill), enter 0134. The leading zero is required on the paper form. This tells the payer this is a hospital outpatient claim that represents the final interim claim for this episode of care. ^[1]

Step 4: Complete the statement covers period (Field 6) showing the dates of service for this final billing period. For this example, enter the start and end dates for week 6 of therapy. Ensure these dates are within the overall treatment period and do not overlap with previously billed interim claims. ^[2]

Step 5: Enter all applicable revenue codes (Field 42) for the services provided during this final period. For physical therapy, this might include revenue code 042X (Physical Therapy) with appropriate subcodes. Include the corresponding charges, units, and HCPCS/CPT codes in the appropriate fields. ^[2]

Step 6: Complete the remaining fields including patient control number, medical record number, attending physician NPI, and any other required information. Review the claim for accuracy, ensuring all interim claims have been previously submitted and that this final claim includes only services not yet billed. ^[2]

Step 7: Submit the claim electronically (or on paper if you have an approved waiver) to the appropriate payer. Retain documentation of the submission and monitor for remittance advice indicating payment or denial. ^[2]

Common Mistakes & Audit Red Flags

Using 0134 when services are not complete: A major error is submitting an interim last claim when the patient is still receiving ongoing outpatient services. This prematurely closes the episode and may result in denied subsequent claims. Only use 0134 when all services for that specific outpatient episode are truly complete. ^[1]

Overlapping dates of service: Ensure the dates on the 0134 claim do not overlap with previously submitted interim claims (0132 or 0133). Overlapping dates create confusion and may trigger audits or denials. Each billing period should have distinct, non-overlapping dates of service. ^[2]

Missing prior interim claims: Submitting a 0134 without having submitted the appropriate preceding interim claims (0132 and/or 0133) is a red flag. Payers expect to see a logical sequence of interim claims leading to the final claim. A standalone 0134 without prior interim billing history may be questioned. ^[1]

Incorrect facility type: Using 0134 for non-hospital settings (e.g., skilled nursing facilities, home health agencies, or clinics) is incorrect. The second digit "1" specifically denotes a hospital facility. For other facility types, use the appropriate two-digit prefix (e.g., 02 for SNF, 03 for home health, 07 for clinics). ^[1]

Billing 0134 for inpatient services: This code is strictly for outpatient services. If the patient was admitted as an inpatient, use the appropriate inpatient bill type (e.g., 0111 for inpatient admit through discharge). Mixing outpatient and inpatient billing codes can lead to claim rejection and payment delays. ^[1]

Failure to reconcile payments: When submitting the final interim claim, ensure that all prior interim payments have been properly applied and reconciled. The 0134 claim should reflect only the remaining balance for the final period, not duplicate charges from earlier periods. ^[2]

Related Codes/Fields

Code/Field	Description	Relationship to 0134
0131	Hospital Outpatient - Admit Through Discharge	Use for single claim covering entire outpatient episode; alternative to interim billing
0132	Hospital Outpatient - Interim First Claim	First interim claim in a series; precedes 0134 in sequence
0133	Hospital Outpatient - Interim Continuing Claims	Ongoing interim claims between first and last; precedes 0134
0135	Hospital Outpatient - Late Charge Only	Use for additional charges after final claim; not a replacement for 0134
0137	Hospital Outpatient - Replacement of Prior Claim	Use to correct a previously submitted claim; different purpose than 0134
0138	Hospital Outpatient - Void/Cancel of Prior Claim	Use to cancel a prior claim; not for final billing
0114	Hospital Inpatient - Interim Last Claim	Inpatient equivalent of 0134 for hospital inpatient services
Field 6	Statement Covers Period	Must show dates for final billing period; should not overlap prior interim claims
Field 42	Revenue Codes	List all applicable revenue codes for services in final period
Field 43	Revenue Description	Describe services provided during final billing period
Field 44	HCPCS/Rates	Include procedure codes for services billed on final claim

^[1] | ^[2]

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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