What Is the UB-04 (CMS-1450) Form?

Who uses the UB-04

The UB-04 is built for institutional billing. Hospitals, skilled nursing facilities, home health agencies, and other facility-based providers may use it when a payer accepts or requires a paper institutional claim. Its fields reflect the needs of facility billing rather than a physician-office service line alone.

This article is intended as a practical office guide. Payer, program, state, and contract requirements can differ, so use the current instructions that apply to the actual claim you are preparing.

What to review before filing

• Institutional fields often depend on one another, so review the claim as a whole.
• Use current facility billing and payer instructions for codes and required fields.
• Verify the printed UB-04 alignment before mailing.

Common problems to avoid

• Copying codes from a prior institutional claim without confirming that the same circumstances apply.
• Reviewing revenue, diagnosis, payer, or provider fields in isolation instead of as part of the full claim.

A practical workflow

1. Start with the current patient, payer, provider, and service records.
2. Enter or import the information into the appropriate form workflow.
3. Review the topic covered in this article together with related fields.
4. Preview or test-print when paper alignment matters.
5. Save a copy and document when the claim or form was submitted.

How software can help

Good software does not decide coding or payer policy for you. It can, however, reduce repetitive typing, keep reusable records organized, make corrections easier to track, and give staff a consistent way to preview and print forms. For this topic, see our UB-04 software.

Key takeaway

The UB-04, also called the CMS-1450, is the paper institutional claim form used by hospitals, facilities, and other institutional providers. It carries different data than the CMS-1500 because institutional billing needs information such as type of bill, revenue codes, statement dates, and facility details.