UB04 Field 55: Estimated Amount Due

Overview

The source document for this reference is the Maryland Medicaid UB-04 Hospital Billing Instructions. In its table of contents, field 55 is listed as “FL 55 Estimated Amount Due” on page 43. The document does not provide any additional instructions, definitions, or examples for this field. The field appears in the sequence between FL 54 (Prior Payments – Payer) and FL 56 (National Provider Identifier – Billing Provider). Because the source is a state Medicaid manual, the field’s presence indicates that the Maryland Medicaid program expects some form of estimated amount to be reported, but no further details are given. ^[1]

When to Use

The source does not specify when field 55 should be completed. No instructions on mandatory or optional use are provided. In the absence of explicit guidance from this document, providers must consult their individual payer contracts, electronic billing specifications, or other payer‑specific manuals to determine if an estimated amount due is required. The field’s title suggests it may be used to indicate the amount the payer or patient is expected to pay, but this is not confirmed by the Maryland Medicaid source. Billers should not assume the field is always required or always omitted; they should verify requirements with each payer. ^[1]

Step-by-Step Claim Example

Because the source contains no example or instruction for field 55, no step‑by‑step guidance can be derived. The only information available is that the field exists in the UB‑04 layout as item 55. To illustrate this limitation, a hypothetical claim line would need to reference payer‑specific rules that are not present in this source. Therefore, no valid claim example using only the provided source can be constructed. Providers should look to other authoritative documents (e.g., NUBC official specifications, Medicare IOM, or individual payer manuals) for concrete examples. ^[1]

Common Mistakes & Audit Red Flags

Since the Maryland Medicaid source does not describe any errors or red flags for field 55, no specific mistakes can be cited. However, a common risk highlighted by the absence of instructions is that billers may either omit the field when it is required or populate it when it should be left blank. Without detailed guidance, inconsistent use across claims could trigger payer‑defined audit flags. Additionally, if a provider relies solely on this source, they may fail to discover payer‑specific billing edits or validations associated with field 55. The lack of documentation itself is a red flag that warrants further investigation. ^[1]

Related Codes/Fields (markdown table)

Field	Name (from source)	Page
FL 54	Prior Payments – Payer	43
FL 55	Estimated Amount Due	43
FL 56	National Provider Identifier (NPI) – Billing Provider	43

The table above shows the adjacent fields in the Maryland Medicaid UB-04 instructions as listed in the source. No further relationship details are provided. ^[1]

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References

[1] Maryland Medicaid — FL 55 — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing%20Instructions%20%281%29.pdf