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UB-92 Completion: Outpatient Services
The UB-92 Claim Form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics, chronic dialysis services and Adult Day Health Care). See UB-92 Completion: Inpatient Services in the Part 2 Inpatient Services Manual for billing instructions for services rendered to a registered hospital inpatient.
If the patient is treated as an outpatient in a hospital different from the one in which the patient is registered, the services must be billed by the treating hospital using the UB-92 Claim Form with the
appropriate facility type code (which is the first two digits in the Type of Bill field [Box 4]) for the outpatient
Most claims for outpatient services can also be submitted through Computer Media Claims (CMC). For CMC ordering and enrollment information, refer to the CMC section in the Part 1 manual.
For additional billing information, refer to the UB-92 Special Billing Instructions for Outpatient Services, UB-92 Submission and Timeliness Instructions and UB-92 Tips for Billing: Outpatient Services sections in this manual.
Note: Certain codes that providers enter on the UB-92 Claim Form changed as a result of the federally mandated Health Insurance Portability and Accountability Act (HIPAA). The following codes changed for Outpatient providers:
Claims for dates of service prior to September 22, 2003, must include the appropriate
Medi-Cal local code. Claims for dates of service on or after September 22, 2003, must
bill the appropriate national code. Claims for services rendered to the same recipient for dates of service both prior to and on or after September 22, 2003 must be submitted on separate claims (split billed), except when billing “from-through” services.
Refer to the Code Correlation Guide at the end of this section to see the correlation between local and national codes. A handy HIPAA In Review guide also is included at the end of this section that summarizes important HIPAA implementation changes.