UB04 Type of Bill Code 0221: Skilled Nursing - Inpatient (Medicare Part B only) - Admit through Discharge Claim

Overview

Type of Bill (TOB) code 0221 is a four-digit alphanumeric code used on the UB-04 claim form to identify a Skilled Nursing Facility (SNF) inpatient stay that is covered under Medicare Part B only and represents a single claim that spans from the patient’s admission through discharge. ^[1] explains that the code structure consists of a leading zero (ignored by CMS), a second digit indicating the type of facility, a third digit indicating the type of care, and a fourth digit indicating the frequency or sequence of the claim. For 0221, the second digit “2” designates a Skilled Nursing Facility (SNF). The third digit “2” signifies “Inpatient Part B” (except for clinics). The fourth digit “1” means “Admit Through Discharge,” indicating that the claim covers the entire inpatient stay from the date of admission to the date of discharge. ^[1] The MassHealth UB-04 Billing Guide provides general instructions for completing the UB-04 form, including field definitions, but does not specifically address TOB 0221. ^[2] However, the guide confirms that the UB-04 is the required paper claim form for institutional providers such as acute inpatient hospitals and skilled nursing facilities. ^[2]

When to Use

^[1] The “Admit Through Discharge” frequency (digit “1”) indicates that the claim is a single, final claim for the entire stay, not an interim or continuing claim. ^[1] The MassHealth UB-04 guide notes that all claims must be submitted electronically unless a waiver is granted, but the UB-04 paper form is still the standard format for those with an approved waiver. ^[2] For MassHealth members, the same TOB structure applies, but providers should follow MassHealth-specific billing instructions for SNF services.

Step-by-Step Claim Example

Scenario: A Medicare beneficiary is admitted to a skilled nursing facility on March 1, 2025, and discharged on March 15, 2025. The patient has exhausted their Part A SNF benefit but has active Part B coverage. The facility will bill Medicare Part B for the entire stay using a single UB-04 claim.

1. Field 4 – Type of Bill: Enter “0221”. The leading zero is required on the paper form. ^[1] The “2” indicates SNF, the second “2” indicates inpatient Part B, and the “1” indicates this is an admit-through-discharge claim. ^[1]

2. Field 6 – Statement Covers Period: Enter “From: 03/01/2025” and “Through: 03/15/2025”. This matches the admission and discharge dates.

3. Field 8 – Patient Name: Enter the beneficiary’s name as it appears on the Medicare card.

4. Field 9a – Patient Control Number: Assign an internal control number (optional but recommended).

5. Field 10 – Patient Birth Date and Sex: Enter date of birth and sex.

6. Field 11 – Patient Address: Enter street, city, state, and ZIP code.

7. Field 12 – Patient ID: Enter the Medicare Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI).

8. Field 13 – Medical/Health Record Number: Enter the facility’s medical record number.

9. Field 14 – Type of Admission: Use code “1” for emergency, “2” for urgent, “3” for elective, or “4” for newborn. For a planned SNF admission, “3” is typical.

10. Field 15 – Source of Admission: Use appropriate code (e.g., “1” for physician referral, “4” for transfer from hospital).

11. Field 16 – Discharge Hour: Enter the hour of discharge (00-23). For a 2:00 PM discharge, enter “14”.

12. Field 17 – Patient Discharge Status: Use code “01” for discharged to home, “03” for transferred to another facility, etc.

13. Field 31 – Occurrence Codes and Dates: Enter any relevant codes (e.g., code “50” for discharge date if not already in field 6).

14. Field 42 – Revenue Codes: List each revenue code for services provided (e.g., 0022 for general medical/surgical care, 0420 for physical therapy, 0430 for occupational therapy). Each revenue code must be on a separate line.

15. Field 43 – Revenue Description: Provide a brief description (e.g., “PT – Individual”).

16. Field 44 – HCPCS/Rates: Enter the HCPCS code for each service (e.g., 97110 for therapeutic exercise).

17. Field 45 – Service Date: For each revenue line, enter the date of service (if different from the statement period). For a single stay, the statement period may suffice.

18. Field 46 – Units: Enter the number of units for each service.

19. Field 47 – Total Charges: Sum all charges for the stay.

20. Field 50 – Payer Identification: Enter “A” for Medicare (primary payer).

21. Field 51 – Provider Information: Enter the SNF’s Medicare provider number and NPI.

22. Field 52 – Release of Information: Sign or mark as appropriate.

23. Field 53 – Assignment of Benefits: Sign or mark as appropriate.

24. Field 54 – Prior Payments: Enter any payments already received (e.g., from a secondary payer).

25. Field 55 – Estimated Amount Due: Leave blank or enter zero if Medicare is primary.

26. Field 56 – NPI: Enter the facility’s National Provider Identifier.

27. Field 57 – Other Provider ID: Enter any other required identifier.

28. **Field

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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