UB04 PPS Code Code 05: CMG (Case Mix Group)

Overview

The provided source ^[1] is a UB-04 Hospital Billing Instructions document from Maryland Medicaid, revised May 2025. The excerpt includes a table of contents that lists form locators up to FL 29 (Accident Sta), but it does not contain any specific definition, usage guidance, or reference to PPS Code 05 (Case Mix Group). Consequently, no information about the meaning, application, or context of Code 05 can be extracted from this source alone.

When to Use

The source does not provide any criteria or scenarios for when to use PPS Code 05. The table of contents and introductory pages focus on general UB-04 field instructions and revenue code matrices, with no mention of Case Mix Group codes. Therefore, based solely on the provided text, there is no available guidance on the appropriate use of this code.

Step-by-Step Claim Example

No claim examples are included in the source snippet. The document begins with a table of contents and a sample UB-04 image, but the excerpt does not extend to the sections that might describe PPS codes or Case Mix Group billing. As a result, a step-by-step example for Code 05 cannot be constructed from this source.

Common Mistakes & Audit Red Flags

The source does not discuss common billing errors or audit red flags related to PPS Code 05. The provided text mentions form locator instructions (e.g., FL 29) but does not address specific pitfalls for Case Mix Group codes. Without additional content, no audit-relevant information is available.

Related Codes/Fields

Related Code/Field	Description	Source
None identified	The source does not list any related codes or fields for PPS Code 05. The document's table of contents references FL 01 through FL 29 and revenue codes, but no cross-reference to Case Mix Group is provided.	[1]

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References

[1] Maryland Medicaid (Code 05) — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf