The UB-04 form is used for which setting?

• A. Outpatient imaging
• B. Professional claims
• C. Home health claims
• D. Facility/hospital inpatient and outpatient institutional claims

Answer: (A)

UB-04 is the standard claim form used by institutional providers to bill for facility charges. This means hospitals and other facilities report the total cost of an encounter—room and board, radiology, labs, supplies, and departmental charges—on this form, using revenue codes to identify each service area. Because it captures the facility’s view of the encounter, it’s used for both inpatient stays and outpatient department visits. Professional claims, on the other hand, are filed on the CMS-1500 form and cover physician or non-facility services billed separately from the facility. Outpatient imaging is a service that occurs within a hospital outpatient setting, but when billed, it falls under facility claims on the UB-04 rather than a professional claim.