UB04 Field 63: Treatment Authorization Code

Overview

Field 63 (Treatment Authorization Code) on the UB-04 claim form is a situational data element used to report the authorization or referral number assigned by a payer when services have been preauthorized or involve a referral. According to CMS Chapter 25, this field is "Situational. Required when an authorization or referral number is assigned by the payer and then the services on this claim AND either the services on this claim were preauthorized or a referral is involved" ^[1]. CMS R1915CP confirms this field is "Situational" ^[2].

When to Use

Field 63 must be completed when a payer has assigned a specific authorization or referral number for the services being billed. According to CMS guidance, this field is required when "an authorization or referral number is assigned by the payer and then the services on this claim AND either the services on this claim were preauthorized or a referral is involved" ^[1]. This typically applies to services requiring prior authorization, such as elective surgeries, high-cost procedures, or specialized treatments. The field is situational for both inpatient and outpatient claims, meaning it is not always required but must be populated when authorization has been obtained ^[3]. Providers should check payer-specific requirements, as some commercial insurers may mandate this field even for services that do not require prior authorization but involve a referral. Failure to include the code when required can lead to automatic claim rejection or recoupment of payments.

Step-by-Step Claim Example

Scenario: A patient requires a total knee replacement (CPT 27447) at a hospital. The payer (Blue Cross Blue Shield) issues authorization number AUTH-2024-98765 after preauthorization.

Step 1: Obtain the authorization number from the payer before rendering services. The authorization letter should clearly state the number and the approved services.

Step 2: On the UB-04 claim form, locate Field 63 (Treatment Authorization Code). This field appears on page 44 of the Maryland Medicaid UB-04 instructions ^[3].

Step 3: Enter the exact authorization number as provided by the payer. In this case, enter "AUTH-2024-98765" in Field 63. Do not add spaces, hyphens, or other characters unless they are part of the original authorization number.

Step 4: Verify that the authorization number matches the services billed. If the authorization covers only the knee replacement but the claim includes additional services (e.g., physical therapy), ensure those services are separately authorized or documented.

Step 5: Submit the claim. The payer will cross-reference Field 63 with their authorization records. If the code matches, the claim processes normally. If not, the claim may be denied or pended for review.

Common Mistakes & Audit Red Flags

Mistake 1: Leaving Field 63 blank when authorization is required. This is the most common error. If a payer assigned an authorization number, the field must be completed ^[1]. Blank fields when authorization is expected trigger automatic denials.

Mistake 2: Using incorrect or expired authorization numbers. Authorization numbers may have expiration dates or be tied to specific service dates. Using an outdated number can result in claim rejection. Always verify the authorization is still valid at the time of service.

Mistake 3: Entering the authorization number in the wrong field. Field 63 is specifically for treatment authorization codes, not for document control numbers (Field 64) or prior payment amounts (Field 54) ^[3]. Confusing these fields can cause processing errors.

Audit Red Flag: Multiple claims with the same authorization number for different patients or services. This may indicate improper authorization usage or billing errors. Payers often audit for duplicate or mismatched authorization codes.

Audit Red Flag: Authorization numbers that do not match payer records. If the code entered in Field 63 does not correspond to an approved authorization in the payer's system, the claim will be flagged for review, potentially delaying payment and triggering a medical necessity review.

Related Codes/Fields

Field Number	Field Name	Relationship to Field 63
FL 64	Document Control Number (DCN)	Used for internal tracking; distinct from authorization codes [3]
FL 54	Prior Payments – Payer	Records payments already made; not related to authorization [3]
FL 55	Estimated Amount Due	Shows expected payment; separate from authorization [3]
FL 39-41	Value Codes and Amounts	May include authorization-related value codes; distinct from Field 63 [3]
FL 71	PPS Code	Used for prospective payment system; not authorization-related [3]

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References

[1] CMS Chapter 25 — FL 63 — 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 63 — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf