HCFA-1500 vs. UB-92: Which one to use?

The answer is quite simple. Individual practitioners should use HCFA-1500. Medical facilities should use UB-92, which is now referred to as UB-04.

Let’s define individual practitioners as non-institutional health care providers or medical professionals, such as individual doctors, nurses, and therapists. They would use the HCFA-1500 form.

Let’s define medical institutions as hospitals, nursing facilities, acute care facilities, stand-alone clinics, surgery centers, sub-acute facilities, home health care agencies, hospice organizations, and psychiatric, drug and alcohol treatment centers. They would use the UB-04 form.

The UB-92 form was replaced by the UB-04 Form per the ruling of the National Uniform Billing Committee in 2005. The UB form is maintained by the NUBC, was formed in 1975 to develop and maintain a single billing form and standard data set to be used nationwide by institutional, private, and public providers and payers for handling health care claims.

The UB is a claim for Medicare Part A reimbursement of both inpatient and outpatient services to Medicare MAC’s and FI’s. It is used in the healthcare industry to submit insurance claims to Medicare or other health insurance companies. Completion of this form helps insurance companies decide whether the healthcare provider should receive reimbursement.

Special Note: Medicare and Medicaid are no longer accepting the UB-92 form, but instead must submit the UB-04 form instead.

UB-04 Blank Form

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