UB04 Patient's Relation to Insured Code 19: Child

Overview

Code 19 in UB-04 Form Locator 59 (Patient's Relation to Insured) indicates that the patient is the child of the insured subscriber. This code is used when the person receiving medical services is the biological, adopted, or stepchild of the primary insurance policyholder. ^[1] The definition aligns with standard insurance industry practices, where children covered under a parent’s policy are identified using this code to ensure proper claim processing and coordination of benefits.

For providers submitting paper or electronic claims, using code 19 accurately ensures the patient’s coverage is linked correctly to the subscriber’s plan.

When to Use

Use code 19 when the patient is a dependent child of the insured person whose name and policy number appear in Form Locators 58 (Insured’s Name) and 60 (Insured’s Group Number). This applies to all types of child relationships recognized by the insurer, including biological children, adopted children, stepchildren, and legal wards under the subscriber’s policy. ^[2]

Do not use code 19 for:

• Spouses (use code 01)
• The insured person themselves (use code 18)
• Employees not related by blood or marriage (use code 20)
• Organ or cadaver donors (use codes 39 or 40)

Step-by-Step Claim Example

Scenario: A 10-year-old patient, Emily Johnson, receives outpatient care at a hospital. Her father, Michael Johnson, holds the primary insurance policy.

Step 1: Complete Form Locator 58 (Insured’s Name)
Enter: JOHNSON, MICHAEL
This identifies the policyholder.

Step 2: Complete Form Locator 59 (Patient’s Relation to Insured)
Enter: 19
This indicates Emily is Michael’s child. Do not use code 01 (spouse) or code 18 (self).

Step 3: Complete Form Locator 60 (Insured’s Group Number)
Enter Michael’s group number (e.g., ABC123). This verifies the specific policy.

Step 4: Complete Form Locator 61 (Insured’s ID Number)
Enter Michael’s policy ID number (e.g., MJ12345).

Step 5: Complete Form Locator 39-41 (Value Codes for COB)
If there is secondary insurance, enter value codes for coordination of benefits. For example, use code 23 (Primary Payer Amount Paid) if applicable.

Step 6: Submit the claim
The payer will recognize code 19 and process Emily’s services under Michael’s policy.

By following this pattern, providers ensure proper linkage of the dependent child to the policyholder, reducing denials.

Related Codes/Fields

Code	Meaning	Field Location
01	Spouse	FL 59
18	Self	FL 59
19	Child	FL 59
20	Employee	FL 59
21	Unknown	FL 59
39	Organ Donor	FL 59
40	Cadaver Donor	FL 59
53	Life Partner	FL 59
G8	Other Relationship	FL 59

The above codes are all valid entries for Form Locator 59 on the UB-04 claim form. ^[1] Code 19 is specifically for the child relationship, and providers should ensure they are selecting the correct code based on the patient’s actual relationship to the insured subscriber.

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References

[1] Novitas Solutions UB-04 Form Locator — https://www.novitas-solutions.com/webcenter/portal/MedicareJH/page4?contentId=00123456

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download