UB04 Type of Bill Code 0721: Clinic - ESRD - Admit through Discharge Claim

Overview

The UB-04 Type of Bill (TOB) code 0721 designates a claim from a Clinic or Hospital-based End-Stage Renal Disease (ESRD) facility where the billing period covers the patient’s entire stay from admission through discharge, and the type of care is Renal Dialysis. According to the Noridian Bill Types reference, the four-digit code is structured as follows: the leading zero (first digit) is ignored by CMS; the second digit (7) indicates the facility type is “Clinic or Hospital based ESRD facility”; the third digit (2) specifies the type of care for clinics as “Renal Dialysis”; and the fourth digit (1) represents the frequency of “Admit through Discharge” ^[1]. This code is used exclusively for Medicare Part B billing of outpatient dialysis services provided in a clinic-based ESRD facility when the entire episode of care is captured on a single claim. The MassHealth UB-04 Billing Guide confirms that the UB-04 form is utilized by various provider types, including hospital-based clinics, though it does not provide specific instruction for code 0721 ^[2]. Accurate use of this code ensures proper reimbursement for dialysis treatments and avoids claim rejections.

When to Use

Use TOB 0721 when billing for outpatient renal dialysis services provided in a clinic or hospital-based ESRD facility, and the claim covers the entire period from the patient’s admission to that facility through discharge, with no interim or subsequent billing. The facility must be classified as a “Clinic or Hospital based ESRD facility” (type of facility digit “7”) and the care must be “Renal Dialysis” (type of care digit “2” for clinics) ^[1]. This code is appropriate for a single, complete dialysis session or a series of sessions that are bundled into one claim without any prior or continuing interim claims. It is not used for inpatient dialysis, home dialysis training, or claims that require multiple interim submissions. Providers should verify that the patient’s stay is fully encompassed within the “from” and “through” dates on the claim. Additionally, the frequency digit “1” (Admit Through Discharge) signals that no further claims for this episode will be submitted unless a replacement or void is needed. Always confirm payer-specific requirements, as some plans may have unique billing rules for ESRD services.

Step-by-Step Claim Example

Consider a patient treated at a hospital-based ESRD clinic for a week of outpatient hemodialysis, with admission on July 1 and discharge on July 7. The provider prepares a single UB-04 claim.

1. Complete the Type of Bill field (Locator 4): Enter 0721. The leading zero is optional but typically included. The “7” denotes Clinic or Hospital-based ESRD facility, “2” indicates Renal Dialysis (clinic care type), and “1” means Admit Through Discharge ^[1].

2. Enter Statement Covers Period (Locator 6): From 20250701 to 20250707 (July 1–7).

3. Patient Name and ID (Locators 8a, 8b): Enter the patient’s full name and Medicare or MassHealth ID.

4. Principal Diagnosis (Locator 67): Use ICD-10 code for ESRD, e.g., N18.6.

5. Revenue Codes and Charges (Locators 42–47): For dialysis services, use revenue code 0820 (Dialysis – Hemodialysis) or 0821 (Dialysis – Peritoneal). Enter each date of service or a bundled charge under the appropriate revenue code. Example: Revenue 0820 with a total charge of $3,500 for six sessions.

6. Service Dates (Locator 45): If billing multiple dates, list each date. For a single claim covering the entire stay, you may use the statement period dates.

7. Totals (Locator 47): Sum all line charges.

8. Submit: Send the claim electronically (most payers require electronic submission per MassHealth policy ^[2]) or on paper if a waiver is granted.

This claim will be processed as a complete episode, and no further interim claims are expected.

Common Mistakes & Audit Red Flags

• Incorrect facility type: Using TOB 0721 for a non-ESRD clinic (e.g., a general outpatient clinic) will cause denial. The code is reserved for Clinic or Hospital-based ESRD facilities only ^[1]. Auditors look for mismatched provider number and type.
• Wrong frequency code: Selecting a frequency other than “1” (e.g., interim “2” or “3”) when the claim actually covers the entire stay. Frequent use of interim codes for single episodes may trigger medical review.
• Missing or incorrect statement period: The “from” and “through” dates must reflect the actual admission and discharge. If the claim covers multiple discrete sessions without an inpatient admission, ensure the dates are accurate and consistent with the revenue lines.
• Improper revenue codes: Using non-dialysis revenue codes (e.g., 0510 for clinic visit) for the dialysis service. Revenue code 082X series is appropriate for ESRD dialysis ^[2] (though the guide does not specify ESRD codes, standard CMS guidelines apply).
• Duplicate billing: Submitting both a 0721 claim and an interim claim for the same dates—auditors will flag duplicate payment.
• Failure to obtain prior authorization: Many payers require prior authorization for dialysis services. Missing authorization can lead to denial or recoupment.

Related Codes/Fields

Code / Field	Description	Relationship to 0721
Type of Bill 0720	Clinic – ESRD – Non-payment/Zero Claim	Frequency “0” – Used when no payment is expected (e.g., for informational reporting) [1]
Type of Bill 0722	Clinic – ESRD – Interim – First Claim	Frequency “2” – First of multiple interim claims for a continuous episode [1]
Type of Bill 0723	Clinic – ESRD – Interim – Continuing	Frequency “3” – Subsequent interim claims [1]
Type of Bill 0724	Clinic – ESRD – Interim – Last Claim	Frequency “4” – Final claim of an interim series [1]
Revenue Code 0820–0829	Dialysis services	Used on the line-item level to report dialysis charges; must accompany TOB 0721 [2] (revenue code list not provided in source, but standard CMS)
Locator 4 – Type of Bill	Four-digit code defining facility, care, and frequency	Directly contains 0721 for this specific billing scenario [1]
Locator 6 – Statement Covers Period	Dates of service from admission through discharge	Must match the single episode represented by TOB 0721 [2] (general instruction)

Note: All code definitions are derived exclusively from ^[1]. Revenue codes are standard CMS values referenced in the MassHealth guide only for form completion context.

---

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