UB04 Type of Bill Code 0821: Specialty Facility - Hospice (Hospital Based) - Admit through Discharge Claim

Overview

The UB‑04 Type of Bill code 0821 represents a claim from a specialty facility providing hospital‑based hospice care submitted as an admit‑through‑discharge (final) claim. According to the Noridian bill‑type structure, the four‑digit code breaks down as follows: leading zero (ignored by CMS), second digit 8 = “Special facility or hospital (CAH, ASC surgery)”, third digit 2 = “Hospice hospital (Special)”, and fourth digit 1 = “Admit Through Discharge” ^[1]. Thus, 0821 is used exclusively for a hospice that is based in a hospital setting when the patient’s entire stay (from admission to discharge) is being billed in a single claim. The code does not cover interim, late‑charge, or adjustment situations; those require different frequency digits (e.g., 2, 3, 4, 5, 7, 8) ^[1]. The MassHealth UB‑04 Billing Guide confirms that the Type of Bill field (field 4) is where this code is entered on paper claims, though MassHealth now requires electronic submission unless a waiver is approved ^[2].

When to Use

Use 0821 when billing for a hospital‑based hospice patient who is admitted and discharged within the same billing period and for whom the provider is submitting a single claim encompassing the entire episode of care. This code is appropriate only when the facility type is a special facility (digit 8) and the care type is hospice hospital (digit 2) ^[1]. It does not apply to hospice services provided in a non‑hospital setting (e.g., home‑based hospice), which would use the third digit “1” (Hospice non‑hospital) instead of “2”. Also, it is not for interim billing; if the hospice stay spans multiple billing cycles, the provider must use frequency codes 2 (first interim), 3 (continuing), or 4 (last interim) ^[1]. The MassHealth guide instructs providers to complete the UB‑04 form accurately for all required fields, including patient name, dates of service, and revenue codes, and to follow the all‑electronic submission policy unless a paper waiver is held ^[2].

Step-by-Step Claim Example

A patient is admitted to a hospital‑based hospice unit on July 1 and discharged on July 15. The provider bills a single claim for the entire stay. The UB‑04 claim is completed as follows:

Field	Entry	Source
Field 4 – Type of Bill	0821	[1]
Field 6 – Statement Covers Period	07/01/XXXX – 07/15/XXXX	[2] (general instructions for date fields)
Field 42 – Revenue Code	0656 (Hospice – General Inpatient)	Example revenue code; not specified in sources but commonly used
Field 43 – Description	“Hospice – General Inpatient”
Field 44 – HCPCS/Rate	Appropriate HCPCS or daily rate
Field 45 – Service Date	Date of each service day
Field 46 – Units	Number of days (15)
Field 47 – Total Charges	Sum of daily charges
Field 50 – Payer	Primary payer (e.g., Medicare Part A)

The claim is submitted electronically (or via paper if a waiver is approved) per MassHealth policy ^[2].

Common Mistakes & Audit Red Flags

1. Using 0821 for non‑hospital hospice – The third digit “2” is specifically for hospital‑based hospice. Using 0811 (third digit “1”) is required for home‑based or freestanding hospice ^[1]. A mismatch may cause denial or recoupment.
2. Incorrect frequency digit – “1” means admit‑through‑discharge. If a stay extends beyond a billing cycle, use frequency 2, 3, or 4. Using 0821 for an interim claim is a common audit flag ^[1].
3. Duplicate billing – Submitting both 0821 and an interim code (0822, 0823, 0824) for the same patient stay will result in duplicate claim edits. Only one admit‑through‑discharge claim per episode is allowed ^[1].
4. Failure to comply with electronic submission – MassHealth requires all claims to be filed electronically unless an approved waiver is on file. Paper claims without a waiver are rejected ^[2].

Related Codes/Fields

Code / Field	Description	Source
0811	Specialty Facility – Hospice (Non‑hospital) – Admit through Discharge	[1]
0822	Specialty Facility – Hospice (Hospital‑based) – Interim First Claim	[1]
0823	Specialty Facility – Hospice (Hospital‑based) – Interim Continuing Claim	[1]
0824	Specialty Facility – Hospice (Hospital‑based) – Interim Last Claim	[1]
0825	Specialty Facility – Hospice (Hospital‑based) – Late Charge Only	[1]
0827	Specialty Facility – Hospice (Hospital‑based) – Replacement of Prior Claim	[1]
0828	Specialty Facility – Hospice (Hospital‑based) – Void/Cancel of Prior Claim	[1]
Field 4 – Type of Bill	Enter the 4‑digit code (e.g., 0821)	[2]
Field 6 – Statement Covers Period	Admission and discharge dates	[2]
Field 67 – Remarks	May include hospice election notice code (e.g., “A”) – not in Noridian source, but common practice	–

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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