What is condition codes in medical billing?

Condition codes refer to specific form locators in the UB-04 form that demand to describe the conditions applicable to the billing period. It is important to note that condition codes are situational. These codes should be entered in an alphanumeric sequence.

What are condition codes on UB04?

CMS1450/UB04 Fields: 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28 are places for Condition Codes. The provider enters the corresponding code (in numerical order) to describe any conditions or events that apply to the billing period.

What means condition code?

Condition codes are extra bits kept by a processor that summarize the results of an operation and that affect the execution of later instructions. These bits are often collected together in a single condition or indicator register (CR/IR) or grouped with other status bits into a status register (PSW/PSR).

What is condition code D3?

D3. Second or subsequent interim PPS bill.

What is a condition code 21?

Condition code 21 indicates services are noncovered, but you are requesting a denial notice in order to bill another insurance or payer source. These claims are sometimes called “no-pay bills” because they are submitted with only noncovered charges on them.

What is A6 condition code?

Special Program

Code	Description
A6	Pneumococcal pneumonia and influenza vaccines paid at 100%.
A9	Second opinion for surgery.
AJ	Payer responsible for co-payment.
AN	Preadmission screening not required.

What does condition code 77 mean?

Enter condition code 77 to report provider accepts the amount paid by primary as payment in full. No Medicare reimbursement will be made. Remarks must be present with a valid reason for requesting conditional payment.

What is condition code 20 used for?

Claims are billed with condition code 20 at a beneficiary’s request, where the provider has already advised the beneficiary that Medicare is not likely to cover the service(s) in question.