Medical Billing Resource

UB-04 / CMS-1450 Resource Center

A field-by-field map of the institutional paper claim form, with focused guides for the form locators billing staff search most often.

Reviewed September 2026 · Educational reference — verify payer and program requirements.

UB-04 / CMS-1450 form locator guide

The UB-04 uses numbered form locators (FLs). This table gives a quick map of the paper form and links the most frequently searched fields to deeper explanations.

FL	Field	Quick reference
1	Billing provider name, address and telephone	Identifies the billing provider. For Medicare, CMS Chapter 25 describes the minimum entry as provider name, city, state and nine-digit ZIP; phone/fax information is desirable.
2	Pay-to name/address and secondary ID	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
3a	Patient control number	The provider-assigned account/control number used to associate the claim with internal financial records.
3b	Medical/health record number	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
4	Type of bill	A key institutional claim code that communicates facility type, bill classification and frequency/sequence information. Verify the exact code with current payer/NUBC instructions.
5	Federal tax number	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
6	Statement covers period	The from and through dates for the billing period. These dates help define the span covered by the institutional claim.
7	Reserved	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
8	Patient name / identifier	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
9	Patient address	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
10	Birth date	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
11	Sex	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
12	Admission / start of care date	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
13	Admission hour	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
14	Priority (type) of admission or visit	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
15	Point of origin for admission or visit	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
16	Discharge hour	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
17	Patient discharge status	Describes the patient status at the end of the billing period. Use current code-set and payer guidance.
18-28	Condition codes	Condition codes provide additional circumstances that apply to the bill. Multiple positions are available; use only codes that are supported by the claim and payer instructions.
29	Accident state	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
30	Reserved	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
31-34	Occurrence codes and dates	Pairs an occurrence code with a date to report significant events affecting the claim.
35-36	Occurrence span codes and dates	Reports a code together with a from/through date span for circumstances that extend over a period.
37	Reserved	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
38	Responsible party name and address	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
39-41	Value codes and amounts	Reports designated value codes with amounts or values when required for the claim.
42	Revenue code	Identifies the revenue center or category associated with each charge line on an institutional claim.
43	Revenue description / related detail	Provides the description associated with the revenue line and may carry designated information under applicable instructions.
44	HCPCS / accommodation rate / HIPPS rate	Reports HCPCS or other line-level service information depending on bill type and setting.
45	Service date	Reports the service date for a revenue line when required.
46	Service units	Reports the number of units associated with the revenue line when applicable.
47	Total charges	Reports charges associated with each revenue line; claim totals should reconcile to the line items.
48	Non-covered charges	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
49	Reserved	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
50	Payer name	Identifies the payer or payers responsible for the claim in the appropriate priority order.
51	Health plan ID	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
52	Release of information	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
53	Assignment of benefits	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
54	Prior payments	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
55	Estimated amount due	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
56	National Provider Identifier (NPI)	Reports the billing provider National Provider Identifier when required.
57	Other provider ID	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
58	Insured name	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
59	Patient relationship to insured	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
60	Insured unique ID	Reports the insured/subscriber identifier used by the payer.
61	Insured group name	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
62	Insured group number	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
63	Treatment authorization codes	Reports authorization or referral identifiers when required by the payer or program.
64	Document control number	Used to report a payer claim control/document control number for applicable replacement or void/cancel workflows.
65	Employer name	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
66	Diagnosis and procedure code qualifier / version indicator	Identifies the diagnosis coding system/version applicable to the diagnosis fields.
67	Principal diagnosis and other diagnosis fields	Reports the principal diagnosis and available additional diagnosis codes for the institutional claim.
68	Reserved	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
69	Admitting diagnosis	Reports the diagnosis identified at admission when applicable.
70	Patient reason for visit	Provides reason-for-visit diagnosis information in designated situations.
71	Prospective payment system (PPS) code	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
72	External cause of injury code	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
73	Reserved	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
74	Principal procedure and other procedure codes/dates	Reports principal and other procedure codes with dates when required.
75	Reserved	See current CMS Chapter 25 and payer/NUBC instructions for the specific reporting requirements.
76	Attending provider	Identifies the attending provider and applicable identifiers.
77	Operating provider	Identifies the operating provider when applicable.
78-79	Other provider	Provides additional provider fields when required.
80	Remarks	Provides remarks when an instruction specifically calls for narrative information; it should not be used as a catch-all replacement for coded fields.
81	Code-code field	Provides qualifier/code/value positions for designated reporting requirements under current instructions.

Institutional billing is code-set heavy. Many UB-04 fields rely on NUBC code sets, payer rules and setting-specific Medicare instructions. Use this page as a locator map, then verify the current authoritative guidance before filing.

UB-04 / CMS-1450 Resource Center

UB-04 / CMS-1450 form locator guide

CMS-1500 vs UB-04 Selector

UB-04 Pre-Submission Checklist

UB-04 Software

Official references