Statement Dates on the UB-04

The date range frames the claim

Service lines and other date-sensitive information should fit the period being billed unless the applicable rules specifically provide otherwise.

Corrections can change date context

A replacement or adjusted claim should be checked as a complete billing period, not merely edited in one line while retaining an inappropriate statement range.

Avoid template dates

Statement dates are inherently claim-specific. They should never survive unnoticed from a copied prior claim.

Institutional-claim review

• Verify the statement “from” and “through” dates against the billing period represented by the claim.
• Compare statement dates with admission/discharge or service dates when those fields apply.
• Clear old statement dates when starting from a copied institutional claim.

Statement dates define the billing period represented by the claim

The statement “from” and “through” dates should be reviewed with the Type of Bill, admission/discharge or service information when applicable, and the services reported on the claim. They are not merely print dates. A copied claim can retain a prior billing period even after service lines are updated, so make statement dates one of the first fields staff reset when starting a new institutional claim.

Sources and verification

Use the CMS institutional-claim sources below for current CMS-1450/UB-04 guidance, then apply the payer’s rules for the facility claim.

• CMS institutional paper claim form (CMS-1450/UB-04)
• CMS Medicare Claims Processing Manual, Chapter 25

Related guides

• Understanding Type of Bill on the UB-04
• Condition Codes on the UB-04
• HCPCS and Procedure Codes on the UB-04