Value Amount & Code

2001-02-02

...

2.3.1May1999

2.4Oct2000

2.5Aug2003

...

Components: <value code (IS)> ^ <value amount (NM)>

Definition: The pair in this field can repeat up to twelve times. UB92 fields 39a, 39b, 39c, 39d, 40a, 40b, 40c, 40d, 41a, 41b, 41c, and 41d. Refer to User-defined Table 0153 - Value code for suggested values. The UB codes listed as examples are not an exhaustive or current list; refer to a UB specification for additional information. This field is defined by HCFA or other regulatory agencies.

Length≤11

62 values


`01`	Most common semi-private rate
`02`	Hospital has no semi-private rooms
`04`	Inpatient professional component charges which are combined billed
`05`	Professional component included in charges and also billed separate to carrier
`06`	Medicare blood deductible
`08`	Medicare life time reserve amount in the first calendar year
`09`	Medicare co-insurance amount in the first calendar year
`10`	Lifetime reserve amount in the second calendar year
`11`	Co-insurance amount in the second calendar year
`12`	Working aged beneficiary/spouse with employer group health plan
`13`	ESRD beneficiary in a Medicare coordination period with an employer group health plan
`14`	No Fault including auto/other
`15`	Worker's Compensation
`16`	PHS, or other federal agency
`17`	Payer code
`21`	Catastrophic
`22`	Surplus
`23`	Recurring monthly incode
`24`	Medicaid rate code
`30`	Pre-admission testing
`31`	Patient liability amount
`37`	Pints of blood furnished
`38`	Blood deductible pints
`39`	Pints of blood replaced
`40`	New coverage not implemented by HMO (for inpatient service only)
`41`	Black lung
`42`	VA
`43`	Disabled beneficiary under age 64 with LGHP
`44`	Amount provider agreed to accept from primary payer when this amount is less than charges but higher than payment received,, then a Medicare secondary payment is due
`45`	Accident hour
`46`	Number of grace days
`47`	Any liability insurance
`48`	Hemoglobin reading
`49`	Hematocrit reading
`50`	Physical therapy visits
`51`	Occupational therapy visits
`52`	Speech therapy visits
`53`	Cardiac rehab visits
`56`	Skilled nurse - home visit hours
`57`	Home health aide - home visit hours
`58`	Arterial blood gas
`59`	Oxygen saturation
`60`	HHA branch MSA
`67`	Peritoneal dialysis
`68`	EPO-drug
`70`	Payer codes
`70 ... 72`	Payer codes	Deprecated
`71`	Payer codes
`72`	Payer codes
`75`	Payer codes
`75 ... 79`	Payer codes	Deprecated
`76`	Payer codes
`77`	Payer codes
`78`	Payer codes
`79`	Payer codes
`80`	Psychiatric visits
`81`	Visits subject to co-payment
`A1`	Deductible payer A
`A2`	Coinsurance payer A
`A3`	Estimated responsibility payer A
`X0`	Service excluded on primary policy
`X4`	Supplemental coverage

2 components


1		O	-	value code
2		O	-	value amount