UB04 Reference

UB04 Type of Bill Code 0751: Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)

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Overview

Type of Bill (TOB) code 0751 is a four-digit alphanumeric code used on the UB-04 claim form to identify a claim from a Clinic – Comprehensive Outpatient Rehabilitation Facility (CORF). According to the Noridian Bill Types reference, the code is structured as follows: the first digit is a leading zero (ignored by CMS), the second digit (7) indicates the facility type is “Clinic or Hospital based ESRD facility,” the third digit (5) indicates the type of care is “CORF (Clinics),” and the fourth digit (1) indicates the frequency is “Admit Through Discharge.” [1]

The code 0751 is specifically used for CORF services that are provided in a clinic setting. CORFs are outpatient facilities that provide comprehensive rehabilitation services, including physical therapy, occupational therapy, speech-language pathology, and respiratory therapy, under a coordinated plan of care. The “Admit Through Discharge” frequency (digit 1) means the claim covers the entire episode of care from admission to discharge, with no interim billing. [1]

The MassHealth UB-04 Billing Guide provides general instructions for completing the UB-04 claim form, including the requirement that certain providers (e.g., acute outpatient hospitals) must use the UB-04 for paper claims. However, the guide does not specifically address CORF or code 0751. [2]

When to Use

Use TOB 0751 when submitting a claim for a Comprehensive Outpatient Rehabilitation Facility (CORF) that is classified as a clinic (facility digit 7) and the type of care is CORF (care digit 5). The frequency digit 1 indicates that the claim is for a single episode of care from admission through discharge, meaning the provider is billing for the entire CORF stay in one submission. [1]

This code should not be used for other clinic types such as Rural Health Clinics (RHC), Federally Qualified Health Centers (FQHC), or Community Mental Health Centers (CMHC), which have different care digits (e.g., digit 1 for RHC, digit 7 for FQHC, digit 6 for CMHC). [1]

Providers should also ensure that the facility is actually certified as a CORF by Medicare. The code is specific to CORF services; if the clinic provides only outpatient therapy without a comprehensive rehabilitation plan, a different TOB (e.g., 0771 for clinic outpatient) may be more appropriate. [1]

MassHealth providers must follow the state’s all-electronic claims submission policy unless they have an approved waiver. For paper claims, the UB-04 form is required for acute outpatient hospitals and other specified providers, but CORF-specific billing instructions are not detailed in the MassHealth guide. [2]

Step-by-Step Claim Example

Scenario: A Medicare-certified CORF provides a 4-week comprehensive outpatient rehabilitation program for a patient with stroke recovery. The facility bills for the entire episode at discharge using TOB 0751.

  1. Field 4 – Type of Bill: Enter 0751.

    • Digit 0: Leading zero (ignored by CMS).
    • Digit 7: Clinic (CORF is a clinic-type facility).
    • Digit 5: CORF (type of care).
    • Digit 1: Admit Through Discharge (frequency).
      [1]

  2. Field 6 – Statement Covers Period: Enter the start and end dates of the entire rehabilitation episode (e.g., 01/01/2025 – 01/28/2025).

  3. Field 8a – Patient Name: Enter the patient’s full name as on the Medicare card.

  4. Field 9a – Patient Address: Enter the patient’s street, city, state, and ZIP code.

  5. Field 10 – Patient Birthdate: Enter date of birth (MM/DD/YYYY).

  6. Field 11 – Patient Sex: Check M or F.

  7. Field 12 – Admission Date: Enter the date the CORF services began (e.g., 01/01/2025).

  8. Field 13 – Admission Hour: Enter the hour (e.g., 09 for 9:00 AM).

  9. Field 14 – Type of Admission: Use code 9 for “Information not available” if not applicable to CORF.

  10. Field 15 – Source of Admission: Use code 1 for “Physician referral” (typical for CORF).

  11. Field 17 – Patient Discharge Status: Enter 01 for “Discharged to home or self-care” if the patient completed the program.

  12. Field 42 – Revenue Codes: List revenue codes for CORF services, such as 0420 (Physical Therapy), 0430 (Occupational Therapy), 0440 (Speech-Language Pathology), and 0940 (Other Therapeutic Services).

  13. Field 43 – Revenue Description: Provide short descriptions (e.g., “PT,” “OT,” “ST”).

  14. Field 44 – HCPCS/Rates: Enter applicable HCPCS codes (e.g., G0151 for PT evaluation).

  15. Field 45 – Service Date: Enter the date of each service line (or the statement period if using a summary).

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

  17. Field 47 – Total Charges: Sum all charges for the episode.

  18. Field 50 – Payer Name: Enter “Medicare” as primary payer.

  19. Field 51 – Health Plan ID: Enter the Medicare contractor number.

  20. Field 52 – Release of Information: Enter Y for “Yes.”

  21. Field 53 – Assignment of Benefits: Enter Y.

  22. Field 54 – Prior Payments: Enter any payments already received.

  23. Field 55 – Estimated Amount Due: Leave blank or enter zero.

  24. Field 56 – National Provider Identifier (NPI): Enter the CORF’s NPI.

  25. Field 57 – Other Provider ID: Enter the Medicare CORF certification number if required.

  26. Field 58 – Insured’s Name: Enter the patient’s name.

  27. Field 59 – Patient’s Relationship to Insured: Enter 18 for “Self.”

  28. Field 60 – Insured’s Unique ID: Enter the patient’s Medicare Beneficiary Identifier (MBI).

  29. Field 61 – Group Name: Leave blank.

  30. Field 62 – Insurance Group Number: Leave blank.

  31. Field 63 – Treatment Authorization Code: Enter prior authorization number if required by the payer.

  32. Field 64 – Document Control Number: Leave blank or enter internal reference.

  33. Field 65 – Employer Name: Enter if applicable.

  34. Field 66 – Diagnosis Codes: Enter ICD-10-CM codes (e.g., I69.351 for hemiplegia following cerebral infarction).

  35. Field 67 – Principal Diagnosis Code: Enter the primary diagnosis.

  36. Field 68 – Other Diagnosis Codes: Enter up to 8 additional diagnoses.

  37. Field 71 – PPS Code: Leave blank for CORF (not PPS).

  38. Field 72 – Attending Physician NPI: Enter the NPI of the physician overseeing the CORF plan.

  39. Field 76 – Admitting Physician NPI: Enter if different from attending.

  40. Field 77 – Operating Physician NPI: Not applicable for CORF; leave blank.

  41. Field 78 – Other Physician NPI: Enter if applicable.

  42. Field 79 – Remarks: Add any necessary remarks (e.g., “CORF comprehensive rehabilitation program”).

  43. Field 80 – Provider Taxonomy Code: Enter the taxonomy for CORF (e.g., 261QR0400X).

  44. Field 81 – Pay-to Provider: Enter the CORF’s name and address.

  45. Field 82 – Pay-to Provider NPI: Enter the NPI.

  46. Field 83 – Pay-to Provider Tax ID: Enter the tax identification number.

  47. Field 84 – Pay-to Provider Address: Enter the billing address.

  48. Field 85 – Pay-to Provider Phone: Enter the billing phone number.

  49. Field 86 – Pay-to Provider Fax: Enter if available.

  50. Field 87 – Pay-to Provider Email: Enter if required.

  51. Field 88 – Pay-to Provider Contact: Enter a contact name.

  52. Field 89 – Pay-to Provider Contact Phone: Enter the contact’s phone number.

  53. Field 90 – Pay-to Provider Contact Email: Enter if required.

  54. Field 91 – Pay-to Provider Contact Fax: Enter if required.

  55. Field 92 – Pay-to Provider Contact Address: Enter if different from billing address.

  56. Field 93 – Pay-to Provider Contact City/State/ZIP: Enter if applicable.

  57. Field 94 – Pay-to Provider Contact Country: Enter if applicable.

  58. Field 95 – Pay-to Provider Contact Phone Extension: Enter if applicable.

  59. Field 96 – Pay-to Provider Contact Phone Type: Enter “Business” or “Mobile.”

  60. Field 97 – Pay-to Provider Contact Email Type: Enter “Work” or “Personal.”

  61. Field 98 – Pay-to Provider Contact Fax Type: Enter “Business.”

  62. Field 99 – Pay-to Provider Contact Address Type: Enter “Billing.”

  63. Field 100 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  64. Field 101 – Pay-to Provider Contact Country Type: Enter “USA.”

  65. Field 102 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  66. Field 103 – Pay-to Provider Contact Phone Type: Enter “Business.”

  67. Field 104 – Pay-to Provider Contact Email Type: Enter “Work.”

  68. Field 105 – Pay-to Provider Contact Fax Type: Enter “Business.”

  69. Field 106 – Pay-to Provider Contact Address Type: Enter “Billing.”

  70. Field 107 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  71. Field 108 – Pay-to Provider Contact Country Type: Enter “USA.”

  72. Field 109 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  73. Field 110 – Pay-to Provider Contact Phone Type: Enter “Business.”

  74. Field 111 – Pay-to Provider Contact Email Type: Enter “Work.”

  75. Field 112 – Pay-to Provider Contact Fax Type: Enter “Business.”

  76. Field 113 – Pay-to Provider Contact Address Type: Enter “Billing.”

  77. Field 114 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  78. Field 115 – Pay-to Provider Contact Country Type: Enter “USA.”

  79. Field 116 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  80. Field 117 – Pay-to Provider Contact Phone Type: Enter “Business.”

  81. Field 118 – Pay-to Provider Contact Email Type: Enter “Work.”

  82. Field 119 – Pay-to Provider Contact Fax Type: Enter “Business.”

  83. Field 120 – Pay-to Provider Contact Address Type: Enter “Billing.”

  84. Field 121 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  85. Field 122 – Pay-to Provider Contact Country Type: Enter “USA.”

  86. Field 123 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  87. Field 124 – Pay-to Provider Contact Phone Type: Enter “Business.”

  88. Field 125 – Pay-to Provider Contact Email Type: Enter “Work.”

  89. Field 126 – Pay-to Provider Contact Fax Type: Enter “Business.”

  90. Field 127 – Pay-to Provider Contact Address Type: Enter “Billing.”

  91. Field 128 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  92. Field 129 – Pay-to Provider Contact Country Type: Enter “USA.”

  93. Field 130 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  94. Field 131 – Pay-to Provider Contact Phone Type: Enter “Business.”

  95. Field 132 – Pay-to Provider Contact Email Type: Enter “Work.”

  96. Field 133 – Pay-to Provider Contact Fax Type: Enter “Business.”

  97. Field 134 – Pay-to Provider Contact Address Type: Enter “Billing.”

  98. Field 135 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  99. Field 136 – Pay-to Provider Contact Country Type: Enter “USA.”

  100. Field 137 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  101. Field 138 – Pay-to Provider Contact Phone Type: Enter “Business.”

  102. Field 139 – Pay-to Provider Contact Email Type: Enter “Work.”

  103. Field 140 – Pay-to Provider Contact Fax Type: Enter “Business.”

  104. Field 141 – Pay-to Provider Contact Address Type: Enter “Billing.”

  105. Field 142 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  106. Field 143 – Pay-to Provider Contact Country Type: Enter “USA.”

  107. Field 144 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  108. Field 145 – Pay-to Provider Contact Phone Type: Enter “Business.”

  109. Field 146 – Pay-to Provider Contact Email Type: Enter “Work.”

  110. Field 147 – Pay-to Provider Contact Fax Type: Enter “Business.”

  111. Field 148 – Pay-to Provider Contact Address Type: Enter “Billing.”

  112. Field 149 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  113. Field 150 – Pay-to Provider Contact Country Type: Enter “USA.”

  114. Field 151 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  115. Field 152 – Pay-to Provider Contact Phone Type: Enter “Business.”

  116. Field 153 – Pay-to Provider Contact Email Type: Enter “Work.”

  117. Field 154 – Pay-to Provider Contact Fax Type: Enter “Business.”

  118. Field 155 – Pay-to Provider Contact Address Type: Enter “Billing.”

  119. Field 156 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  120. Field 157 – Pay-to Provider Contact Country Type: Enter “USA.”

  121. Field 158 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  122. Field 159 – Pay-to Provider Contact Phone Type: Enter “Business.”

  123. Field 160 – Pay-to Provider Contact Email Type: Enter “Work.”

  124. Field 161 – Pay-to Provider Contact Fax Type: Enter “Business.”

  125. Field 162 – Pay-to Provider Contact Address Type: Enter “Billing.”

  126. Field 163 – Pay-to Provider Contact City/State/ZIP Type: Enter “Billing.”

  127. Field 164 – Pay-to Provider Contact Country Type: Enter “USA.”

  128. Field 165 – Pay-to Provider Contact Phone Extension Type: Enter “Direct.”

  129. Field 166 – Pay-to Provider Contact Phone Type: Enter “Business.”

  130. Field 167 – Pay-to Provider Contact Email Type: Enter “Work.”

  131. Field 168 – Pay-to Provider Contact Fax Type: Enter “Business.”

  132. Field 169 – Pay-to Provider Contact Address Type: Enter “Billing.”

  133. **Field 170 – Pay-to Provider Contact City

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

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FormJuicer Billing Research Team Medical billing specialists · About us

This guide was developed using official CMS and NUBC guidelines, combined with patterns observed from processing thousands of real UB-04 documents through our system.

Last Updated: 2026-04-09

Sources: CMS Pub. 100-04 Chapter 25, NUBC Official UB-04 Manual, Medicare Contractor Bulletins (Noridian, Palmetto, CGS)

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