Overview
The National Uniform Billing Committee (NUBC) defines field numbers and descriptions for the UB‑04 claim form. The Maryland Medicaid UB-04 billing instructions list field numbers and their purposes [1]. The source does not include field 59 or a code 39 for organ donor status. Accurate claim submission requires understanding the correct assignment of each field.
When to Use
The Maryland Medicaid UB-04 instructions define all field numbers and their associated codes based on NUBC standards. Providers should refer to the official NUBC manual for the complete list of patient‑insured relationship codes and their applicable field placement. No specific guidance on code 39 is provided in the cited source.
Step-by-Step Claim Example
Scenario: A hospital bills for a patient’s post‑operative care. The payer information is entered in Fields 50–52 (Payer Name, Health Plan ID, Release of Information) using the insurer’s details [1]. Revenue codes are populated in FL 42 and service dates in FL 45 [1]. The claim is submitted according to payer contracts.
Common Mistakes & Audit Red Flags
- Confusing FL 39–41 (Value Codes) with patient‑relation codes. The Maryland Medicaid instructions clearly separate FL 39–41 (value codes/amounts) from other fields [1].
- FL 38 is for Responsible Party Name and Address, and FL 31–34 are for Occurrence Codes and Dates – each field has a distinct purpose as defined by the source.
Related Codes/Fields (Markdown Table)
| Code / Field | Description | Source Reference |
|---|---|---|
| FL 38 | Responsible Party Name and Address – not for relation codes | [1] |
| FL 39–41 | Value Codes and Amounts – separate from patient relation | [1] |
| FL 42 | Revenue Codes – used for service‑type identification | [1] |
| FL 50–52 | Payer Name, Health Plan ID, Release of Information – required for all payers | [1] |
References
[1] Maryland Medicaid — UB‑04 Hospital Billing Instructions — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf
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Start ExtractingThis 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: 2026-05-29
Sources: CMS Pub. 100-04 Chapter 25, NUBC Official UB-04 Manual, Medicare Contractor Bulletins (Noridian, Palmetto, CGS)