Type of bill codes are three-digit codes located on an Institutional/Facility Claim that describe the type of bill a provider is submitting to a payer. In a Choice database, this information is stored in the Bill Code field in Service Location setup; only the first and second digits are used. Each digit has a specific purpose and is required on an Institutional/Facility Claim in order to be submitted to the payer.

First Digit = Type of Facility

Digit
Description
1 Hospital
2 Skilled Nursing Facility (SNF)
3 Home Health
4 Religious Nonmedical (Hospital)
5 Religious Nonmedical (Extended Care) - discontinued 10/01/2005
6 Intermediate Care
7 Clinic or Hospital Based End Stage Renal Disease (ESRD) Facility - requires special second digit
8 Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) - requires special second digit
9 Reserved for National Assignment

Second Digit = Type of Care

DigitDescription
1
  • Except Clinics & Special Facilities - Inpatient Part A
  • Clinics Only - Rural Health Center (RHC)
  • Special Facilities Only - Hospice (non-hospital based)
2
  • Except Clinics & Special Facilities - Inpatient Part B (includes Home Health Agency (HHA) visits under a Part B plan of treatment
  • Clinics Only - Hospital based or Independent Renal Dialysis Center
  • Special Facilities Only - Hospice (hospital based)
3
  • Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment)
  • Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC)
  • Special Facilities Only - ASC Services to Hospital Outpatients
4
  • Except Clinics & Special Facilities - Other Part B (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients", and referenced diagnostic services)
  • Clinics Only - Other Rehabilitation Facility (ORF)
  • Special Facilities Only - Free Standing Birthing Center
5
  • Except Clinics & Special Facilities - Intermediate Care-Level I
  • Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Special Facilities Only - CAH
6
  • Except Clinics & Special Facilities - Intermediate Care-Level II
  • Clinics Only - Community Mental Health Center (CMHC)
  • Special Facilities Only - Residential Facility (not used for Medicare)
7
  • Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required), Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved sing bed agreement)
  • Clinics Only - Reserved for National Assignment
  • Special Facilities Only - Reserved for National Assignment
8
  • Except Clinics & Special Facilities - N/A
  • Clinics Only - Reserved for National Assignment
  • Special Facilities Only - Reserved for National Assignment
9
  • Except Clinics & Special Facilities - Reserved for National Assignment
  • Clinics Only - Other
  • Special Facilities Only - Other

Third Digit = Frequency (NOTE: This is set by default to 1 in the Choice application. There are ways to change it if necessary; please contact the Customer Success team for assistance.)

DigitDescription
0 Nonpayment or Zero Claims
1 Admit through Discharge Claim
2 Interim (First Claim)
3 Interim (Continuing Claims)
4 Interim (Last Claim)
5 Late Charge Only
7 Replacement of Prior Claim -or- Corrected Claim
8 Void -or- Cancel of a Prior Claim
9 Final Claim for a Home Health PPS Episode

Resources:

CMS Internet Only Manual (IOM), Publication 100-04, Chapter 25, Section 75.1

Type of Bill Code Structure, Noridian Healthcare Solutions

Type of Bill Codes for the UB-04 Claim Form, verywell health