UB04 Field 71: PPS Code

Overview

Field 71 (PPS Code) is a reserved location on the UB-04 form intended for a Prospective Payment System (PPS) code. However, its usage is entirely payer‑specific. Under Medicare, the field is explicitly not used; any data entered by the provider will be ignored by the Medicare claims processing system ^[1]. This policy is reaffirmed in CMS transmittal R1915CP, which states: “FL71 – Prospective Payment System (PPS) Code Not used” ^[2]. For state Medicaid programs, the field may be recognized. For example, the Maryland Medicaid UB-04 instruction set includes FL71 as a defined field within its table of contents, though no specific billing requirement is provided in the excerpted source ^[3]. Providers should confirm with their specific payer contract whether the field is to be left blank, ignored, or populated with a designated code. In the absence of explicit instructions, leaving Field 71 blank is the safest approach to avoid data‑rejection issues.

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When to Use

The appropriate use of Field 71 depends entirely on the payer being billed. For Medicare fee‑for‑service claims, the field must be left blank; entering any value will be discarded by the fiscal intermediary or MAC ^[1]. Medicare Advantage plans may have their own rules, but typically they follow Medicare Part A guidelines. For state Medicaid programs, some states, such as Maryland, list FL71 in their form layout, which suggests the field may be used for a state‑specific PPS code, but no operational details are provided in the available source ^[3]. Providers should consult their state Medicaid provider manual or a local billing guide to determine if PPS code reporting is required. It is safest to treat Field 71 as optional and normally unpopulated unless the payer explicitly instructs otherwise. When in doubt, the provider should leave the field blank and not include any extraneous data that could trigger an edit or delay payment.

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Step-by-Step Claim Example

Since Field 71 is generally not used for Medicare and often ignored by other payers, here is a practical example illustrating correct submission:

Scenario: A hospital submits an inpatient UB-04 claim to Medicare for a DRG‑assigned stay. The billing system automatically generates fields 1–70 per standard guidelines.

1. Locate Box 71 on the UB-04 form. (For electronic 837I, this maps to the PPS Code segment, typically not sent.)
2. Do not enter any value. Ensure the field is either blank or contains a space/zero only if the software requires something.
3. Verify payer expectations. For Medicare, the claim will process correctly even if Field 71 is empty. For a hypothetical state Medicaid that uses a PPS code, obtain the required code from the state’s fee schedule or billing manual.
4. Test submission. If unsure, submit a test claim to the payer’s clearinghouse. If the claim is rejected due to Field 71, the rejection message will indicate the required format.
5. Example output for Medicare: Box 71 is empty. The claim proceeds through the fiscal intermediary without comment.

In the unusual case that a payer requires a code (e.g., a state‑specific PPS indicator), populate with the exact value (e.g., “01” for standard PPS or “02” for alternate PPS) per that payer’s instructions. Always document the source of the requirement.

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Common Mistakes & Audit Red Flags

• Entering a value on Medicare claims: The most common mistake is populating Field 71 with a code from a previous payer system or from outdated software. Medicare will ignore the data, but the presence of a value could cause confusion in downstream reconciliation or trigger a manual review if the value is unexpected. Leave it blank ^[1].
• Assuming all payers ignore the field: Some state Medicaid plans or commercial contracts may indeed use this field. Failure to populate a required PPS code can result in claim denial or delayed payment. Always verify the specific payer’s billing instructions.
• Misidentifying the field usage: This leads to unnecessary data entry and the risk of incorrect coding.
• Audit red flags: If an auditor sees Field 71 populated on a Medicare claim, they may investigate whether the provider is billiing under a different PPS system (e.g., psychiatric PPS) incorrectly. For other payers, inconsistent use of the field across multiple claims may indicate a lack of standardized billing procedures. To avoid audit attention, standardize your UB-04 configuration to leave Field 71 blank except where explicitly mandated.

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Related Codes/Fields

The following table lists fields on the UB-04 that are related to prospective payment or Medicare payment systems. Note that Field 71 is the designated PPS code field, but its use is payer‑dependent.

Field Number	Field Name	Purpose	Usage Note
71	PPS Code	Intended for Prospective Payment System code	Medicare: Not used; data ignored. Other payers: Conditional.
70a–q	Patient’s Reason for Visit Code	Outpatient reason for visit (similar to PPS grouping)	Used for outpatient PPS classification for certain payers.
74	Principal Procedure Code and Date	Procedure code for inpatient PPS (MS‑DRG assignment)	Required on inpatient claims when a procedure is performed.
57	Other (Billing) Provider Identifier	Often used for PPS‑related provider numbers	Required by some Medicare Administrative Contractors.
63	Treatment Authorization Code	May relate to PPS authorization in managed care	Situational; linked to prior authorization for PPS services.

These fields are described in the UB-04 manual and payer‑specific instructions. Providers should cross‑reference Field 71 with the payer’s PPS policies to ensure compliance ^[3]; ^[1].

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References

[1] CMS Chapter 25 — FL 71 — 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 71 — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf