What is the value code on a claim form?
Asked by: Dariana Williamson | Last update: June 9, 2025Score: 4.5/5 (68 votes)
What is the value code of a claim?
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
What does value code 12 mean?
1 VALUE CODES FL 39-41 Enter the value codes “12” to indicate Working Aged insurance, or “43” to indicate Disability insurance and the amount you were paid by the primary insurance.
What is value code 01 and 02?
01. Most common Semi-Private Rate - to provide for recording hospital's most common semi- private rate. 02. Hospital has no semi-private rooms - using this code requires $0.00 amount.
What is value code 80 on claim?
Value Codes: 80 – Covered days. 81 – Non-covered days. 82 – Coinsurance days.
Intro to UB 04
What is value code 40?
40. New Coverage Not Implemented by Managed Care Plan. (For inpatient service only.) Inpatient charges covered by the Managed Care Plan. (The hospital uses this code when the bill includes inpatient charges for newly covered services that are not paid by the Managed Care Plan.
What is the value code 85?
Value Code 85 is defined as “County Where Service is Rendered.” The FIPS state and county code can be found at the following websites: United States Census Bureau. CMS' SSA to FIPS State and County Crosswalk.
What is the value code 24?
The new data circled in the green box is the new information to be used for billing. The Value Code and Value Code Amount are data elements that identify essential information to pay a claim. The “Value Code” of “24” stands for the “Medicaid Rate Code”.
What is the value code 49?
Effective January 1, 2006 the definition of value code 49 is changed to indicate the patient's most recent hematocrit reading taken before the start of the billing period. 67 - Peritoneal Dialysis - The number of hours of peritoneal dialysis provided during the billing period.
What does value code 09 mean?
The coinsurance amount is based upon the inpatient hospital deductible for the. year in which days are used. The data is reported on the CMS-1450 as follows: Value Code 09, Medicare Coinsurance Amount in First Calendar Year $ 1,141.00. Value Code 11, Medicare Coinsurance Amount in Second Calendar Year $
What is value code 16?
If the primary payer is billed, and payment is not received but you do not receive payment for a valid reason (for all primary payers except Medicare Secondary Payer (MSP) value code 16 - Public Health Services portion of a higher priority or other Federal agency, or value code 42 - Veterans Administration); a ...
What is value code 82?
• Value code 82 -- Co-insurance days. Description: The inpatient Medicare days occurring after the 60th, and before the 91st day, or inpatient SNF/Swing bed days occurring after the 20th, and before the 101st, day in a single spell of illness.
What is the value code 79?
79 – Total payments for services applicable to the ESRD – The Medicare shared system will display this payer only code on the claim. The value represents the dollar amount for Medicare allowed payments applicable for the calculation in determining an outlier payment.
What is an example of a claim of value?
If you construct a position claiming that something is good or bad or one thing is better than another, you've made a claim of value. Examples of claims of value are: "The Wizard of Oz is the greatest movie of all time," "Snowboarding is the greatest way to spend a vacation," or, "Indian food is the best food of all."
How do you calculate the value of a claim?
These are calculated based on the actual financial losses the claimant has suffered up to the date of the settlement or trial, and any future losses they might incur. This can include: Medical expenses and rehabilitation costs. Loss of earnings and future earning capacity.
What is condition code 01?
Understanding the Conditions/Situations Mentioned by NUBC
The NUBC's 2007 manual lists 99 situations with numeric codes ranging from 01-99. For example, sub-code 01 refers to the Military Service-Related situation explained as medical conditions incurred during military service.
What is a value code on a claim?
The code indicating a monetary condition which was used on an institutional claim. Source: Medicare Advantage Organizations (MAOs)
What is the value code 61 on a claim?
One of the most commonly used value codes on hospice claims is value code 61, which is used to report the location of the site of hospice services. When Type of Bill 081X or 082X is submitted with a claim line with revenue code 0651or 0652 without value code 61, the claim will deny.
What is value code 63?
63. Number of Low Routine Home Care Days. Days that come after the first 60 days of a routine home care hospice claim.
What is value code 48 or 49?
Effective January 1, 2006 the definition of value code 48 is changed to indicate the patient's most recent hemoglobin reading taken before the start of the billing period. 49 - Hematocrit Reading - Code indicates the hematocrit reading taken before the last administration of EPO during this billing cycle.
What is value code 23?
Medicare RA. 39 thru 41 a-d Value Codes and Amounts Patient's Share of Cost: Enter code 23 and the patient's Share of Cost for the claim. Leave blank if not applicable. Medicare Deductible: Enter code A1 if Medicare is the primary payer, or B1 if Medicare is a secondary payer.
What is value code 51?
51 Occupational therapy visits - Indicates the number of occupational therapy visits from onset (at the billing provider) through this billing period. 52 Speech therapy visits - Indicates the number of speech therapy visits from onset (at billing provider) through this billing period.
What is value code 45?
Value codes Accident hour–For inpatient claims, if the patient was admitted as the result of an accident, enter value code 45 with the time of the accident using military time (00 to 23).
What is value code 44?
Value code 44
Medicare uses the amount the provider is obligated to accept as payment in full in its payment calculation. In such cases, the provider reports in value code 44 the amount it is obligated to accept as payment in full. Medicare considers this amount to be the provider's charges.
What is value code 68?
68 - Erythropoietin Units - Code indicates the number of units of administered EPO relating to the billing period and reported in whole units to the left of the dollar/cents delimiter. NOTE: The total amount of EPO injected during the billing period is reported.