UB04 Type of Bill Code 0137: Hospital Outpatient - Replacement of Prior Claim

Overview

The UB-04 Type of Bill code 0137 is a four-digit alphanumeric code used specifically for Hospital Outpatient - Replacement of Prior Claim. The code structure breaks down as follows: the leading "0" is ignored by CMS, the "1" indicates a hospital facility, the "3" signifies outpatient care, and the "7" denotes a replacement of a prior claim. ^[1]

This code is part of the standardized Type of Bill system used by Medicare and many other payers. The frequency digit "7" specifically means the provider is submitting a corrected or adjusted claim to replace a previously submitted and processed claim. ^[1]

Providers use this code when they need to correct errors on a previously submitted outpatient hospital claim, such as incorrect dates of service, diagnosis codes, procedure codes, or charges. The replacement claim must contain all the correct information and will completely replace the original claim in the payer's system. ^[1]

When to Use

Use Type of Bill 0137 when you are a hospital provider submitting an outpatient claim that replaces a previously submitted and processed claim. This applies to situations where the original claim contained errors that need correction, such as wrong patient demographics, incorrect revenue codes, or miscalculated charges. ^[1]

This code should not be used for initial claims (use 0131 for admit through discharge), interim claims (0132, 0133, 0134), late charges (0135), or voiding a claim (0138). The replacement code is specifically for correcting a claim that has already been paid or denied, not for submitting additional charges or canceling a claim. ^[1]

For MassHealth providers, note that effective January 1, 2012, MassHealth adopted an all-electronic claims submission policy. All claims, including replacement claims with code 0137, must be submitted electronically unless the provider has received an approved electronic claim submission waiver. ^[2]

Step-by-Step Claim Example

Scenario: A hospital outpatient department submitted a claim for an MRI procedure on 01/15/2025 with Type of Bill 0131 (Hospital Outpatient - Admit Through Discharge). The claim was processed and paid, but the hospital discovered the diagnosis code was incorrect (M54.5 instead of M54.4). The hospital needs to submit a replacement claim.

Step 1: Complete a new UB-04 claim form with all the same information as the original claim, except for the corrected diagnosis code.

Step 2: In Field 4 (Type of Bill), enter 0137. The "0" is the leading zero (ignored by CMS), "1" indicates hospital, "3" indicates outpatient, and "7" indicates replacement of prior claim. ^[1]

Step 3: Enter the original claim's control number in Field 64 (Document Control Number) or as required by the payer to link the replacement to the original claim.

Step 4: Complete all other required fields with the corrected information. For the MRI claim, ensure the correct diagnosis code (M54.4) is entered in Fields 67A-67Q.

Step 5: Submit the claim electronically (or on paper if a waiver has been approved) to the payer. The replacement claim will completely replace the original claim in the payer's system. ^[2]

Common Mistakes & Audit Red Flags

Using 0137 for late charges: A common error is using code 0137 to submit additional charges for services provided after the original claim was submitted. Late charges should use code 0135 (Late Charge Only), not 0137. ^[1]

Using 0137 instead of 0138 for voiding: If you need to cancel a claim entirely, use code 0138 (Void/Cancel of Prior Claim), not 0137. Replacement claims correct errors, while void claims cancel the original claim. ^[1]

Incorrect facility type: Ensure the second digit is "1" for hospital. Using "2" (SNF) or "7" (Clinic) would be incorrect for hospital outpatient services. ^[1]

Missing original claim reference: Failure to include the original claim's control number or other required reference information may result in the replacement claim being processed as a new claim rather than a correction. ^[2]

Audit red flags: Payers may flag replacement claims that significantly increase charges, change primary diagnosis codes, or are submitted long after the original claim was processed. Frequent use of replacement codes may trigger medical review or prepayment audits.

Related Codes/Fields

Code/Field	Description	Relationship to 0137
0131	Hospital Outpatient - Admit Through Discharge	Initial claim type; 0137 replaces this type of claim
0135	Hospital Outpatient - Late Charge Only	Used for additional charges, not corrections
0138	Hospital Outpatient - Void/Cancel of Prior Claim	Used to cancel, not correct, a prior claim
0127	Hospital Inpatient - Replacement of Prior Claim	Same replacement function but for inpatient services
0837	Special Facility - Replacement of Prior Claim	Replacement for CAH or ASC facilities
Field 64	Document Control Number	Used to reference the original claim being replaced
Field 67A-Q	Diagnosis Codes	Often corrected in replacement claims
Field 42-43	Revenue Codes	May be corrected in replacement claims

^[1]

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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