Key points
- A copied code with a new amount—or a copied amount with a new code—can change the claim meaning.
- Amounts, units, or other values may have payer-specific formatting rules.
- Value-code requirements can vary by program and billing situation.
Meaning and number belong together
A copied code with a new amount—or a copied amount with a new code—can change the claim meaning. Verify both from the applicable source record.
Formatting matters
Amounts, units, or other values may have payer-specific formatting rules. Do not infer decimal placement or units from a prior claim.
Use current payer guidance
Value-code requirements can vary by program and billing situation. Apply the payer's current instructions for the service being billed.
Institutional-claim review
- Review each value code together with its associated amount or value.
- Confirm that the code is required for this payer/claim type and that the value uses the correct units or monetary format.
- Do not carry forward value-code data simply because it appeared on a previous institutional claim.
Value codes pair a meaning with a value
A value code is incomplete without the associated amount or other value required by the code. Review both elements together and confirm the current payer/CMS/NUBC instructions for the claim type. In reusable claims, delete old value-code entries before entering the new encounter because an apparently reasonable amount can be left behind even when the code itself has been changed.
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
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