UB04 Field 44: HCPCS/Rates

Overview

Field 44 (HCPCS/Rates) on the UB-04 claim form is a required element for both inpatient and outpatient billing, as stated by CMS guidelines. ^[1] specifies that the field is “Required” and must contain either a HCPCS code for outpatient services, an accommodation rate for inpatient bills, or a HIPPS rate code. ^[2] reiterates that “FL 44 - HCPCS/Rates/HIPPS Rate Codes Required.” The Maryland Medicaid UB-04 instructions list the field as “FL 44 HCPCS/RATES/HIPPS Rate Codes” within their table of contents, confirming its presence across payers. ^[3] The field serves to identify the specific procedure (via HCPCS), the daily room and board charge (via a rate code), or a HIPPS code used for prospective payment systems. Accurate entry in Box 44 is essential for claim adjudication and reimbursement.

When to Use

Field 44 must be populated in every UB-04 claim, whether for inpatient or outpatient services. For outpatient claims, the provider enters the HCPCS code that describes the procedure performed. ^[1] states: “When coding HCPCS for outpatient services, the provider enters the HCPCS code describing the procedure here.” For inpatient claims, the accommodation rate for the room and board charge is entered instead of a HCPCS code. ^[1] notes that “on inpatient hospital bills the accommodation rate is shown here.” Additionally, the field accommodates Health Insurance Prospective Payment System (HIPPS) rate codes. ^[1] The Maryland Medicaid instruction also refers to “HIPPS Rate Codes,” confirming this usage. ^[3] The field is mandatory regardless of payer, though the exact format (HCPCS, rate, or HIPPS) depends on the type of service and the billing scenario.

Step-by-Step Claim Example

Consider an outpatient hospital visit where a patient receives a Level 3 Evaluation and Management service, CPT code 99213. The claim line in Box 44 would contain the HCPCS code “99213.” ^[1] instructs that for outpatient services, “the provider enters the HCPCS code describing the procedure here.” In the adjoining Box 42 (Revenue Code), the provider would use a code such as 0510 (Clinic Visit), and in Box 46 (Units) the count of services (e.g., 1). ^[3] lists the relationship of these fields in its table of contents (FL 42 Revenue Codes, FL 44 HCPCS, FL 45 Service Date, FL 46 Units). For an inpatient stay, assume a private room accommodation. Box 44 would display the daily rate, for example “$850.00” (or a specific rate code like “7701” depending on payer convention). ^[1] states that “on inpatient hospital bills the accommodation rate is shown here.” The corresponding Revenue Code in Box 42 would be 0110 (Private Medical/Surgical). If the inpatient stay is subject to a HIPPS-based PPS, the provider would instead enter the HIPPS rate code (e.g., “HCC02”) in Field 44. ^[1] mentions that “Health Insurance Prospective Payment System (HIPPS) Rate Codes” are also used in this field.

Common Mistakes & Audit Red Flags

One frequent error is omitting a HCPCS code on outpatient claims, which leads to claim rejection or denial. ^[1] clearly requires the HCPCS code to be entered; its absence violates billing rules. Another mistake is using a HCPCS code on inpatient bills instead of an accommodation rate or HIPPS code. ^[1] differentiates between outpatient (HCPCS) and inpatient (accommodation rate) entries. Mixing rate types — for example, entering a HIPPS code on a claim where a standard accommodation rate is expected — can trigger audits. ^[2] confirms the requirement for HIPPS codes, implying they must be used only in appropriate PPS settings. Additionally, misalignment with Revenue Code (Box 42) is a red flag: an accommodation rate in Box 44 should pair with a room revenue code (01xx series). ^[4] lists FL 42 (Revenue Codes) and FL 44 sequentially, indicating the two fields must correlate. Payers may downcode or deny claims that show a HCPCS code with an inpatient revenue code. To avoid flags, providers must verify the correct field content per bill type and service category.

Related Codes/Fields

The following table lists fields on the UB-04 that frequently interact with or are adjacent to Field 44, based on the Maryland Medicaid instruction’s table of contents. ^[3]

Field	Name	Relationship to Field 44
FL 42	Revenue Code	Identifies the type of service (e.g., room, clinic) that the HCPCS or rate in FL 44 supports.
FL 43	National Drug Code (NDC)	Used for drug‑administered line items; FL 44 may contain the corresponding HCPCS J-code.
FL 45	Service Date	Defines the date the HCPCS procedure was performed or the rate applied.
FL 46	Units of Service	Count of times the HCPCS code or rate is charged; must align with FL 44.
FL 47	Total Charges	Sum of charges for the line; FL 44’s rate multiplied by FL 46 units is part of this total.
FL 48	Non‑Covered Charges	If the HCPCS code or rate is not covered, the non‑covered portion is entered here.

These fields collectively ensure that the service described by the HCPCS, rate, or HIPPS code in Box 44 is properly identified, dated, and quantified for processing. ^[1] also notes that HCPCS codes used for Medicare “are available from Medicare contractors,” linking Field 44 to external code sets.

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References

[1] CMS Chapter 25 — FL 44 — https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c25.pdf

[2] CMS R1915CP — https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1915CP.pdf

[3] Maryland Medicaid — FL 44 — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf

[4] Maryland Medicaid — FL 44 — https://health.mayland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf