UB04 Occurrence Codes List (2025)

UB04 Occurrence Codes are located in boxes 31 to 34 providing specific information of patient like patient condition, healthcare issues, etc. Occurrence codes are play important role in billing and payment of claims.

• Occurrence codes are 2 digit codes used in UB04 form for specify the patient’s health condition.
• These codes used by insurance payers for understand the purpose of claim reimbursement as per patient condition.

List of Occurrence Codes for UB04

(UB04 Field Locater- 31 – 34)

Codes	Description
01	Accident or Medical Payment Coverage – Date of accident for which there is medical payment coverage. Reported with VC 14 or VC 47. If filing for a Conditional Payment, Report with Occurrence Code 24.
02	No-Fault Insurance (include automobile and other accidents) – Date of accident/injury for which the state has applicable No-Fault laws. Reported with VC 14 or 47. If filing for a Conditional Payment, report with Occurrence Code 24.
03	Accident/Tort Liability – Date of an accident/injury resulting from a third party’s action that may involve a civil court action in an attempt to require payment by third party, other than No-Fault. Reported with VC 47.
04	Accident/Employment-Related – Date of an accident/injury related to beneficiary’s employment. Reported with VC 15 or VC 41. If filing for a Conditional Payment, report with Occurrence Code 24.
05	Accident/No Medical Payment, No-Fault or Liability Coverage – Date of accident/injury for which there is no Medical Payment or other third-party liability coverage
06	Crime victim – Date on which a medical condition resulted from alleged criminal action committed by one or more parties
18	Date of Retirement of Beneficiary
19	Date of Retirement (Spouse)
24*	Date Insurance denied – Date of receipt of a denial of coverage by a higher priority payer. This could be date of primary payer’s Explanation of Benefit (EOB) statement, letter or other documentation. Date is required on all Conditional Payment claims.
25	Date Coverage No Longer Available – Date on which coverage, including Workers’ Compensation benefits or No-Fault coverage, is no longer available to beneficiary
33	First day of MSP ESRD coordination period for ESRD beneficiaries covered by an EGHP
Explanation of Star (*)	Maintain documentation on file that supports the request for conditional payment from Medicare, such as the primary payer’s EOB statement, denial/rejection letter, etc.

Value Codes (VCs)

(UB04 Field Locator 39-41)

Codes	Description
12	Working aged beneficiary/spouse with an EGHP (beneficiary over 65). Beneficiary must have Medicare Part A entitlement (enrolled in Part A) for this provision to apply. Primary Payer Code = A.
13	ESRD beneficiary with EGHP in MSP/ESRD 30-month coordination period. Primary Payer Code = B.
14	No-Fault including automobile/other. Examples: Personal injury protection (PIP) and medical payment coverage. Requires OC 01 or 02 with date of accident/injury. Primary Payer Code = D. If filing for a Conditional Payment, report with Occurrence Code 24.
15	Workers Compensation (WC). Requires CC 02 and OC 04 with date of accident/injury. Primary Payer Code = E. If filing for a Conditional Payment, report with Occurrence Code 24.
16	Public health services (PHS) or other federal agency. Conditional billing does not apply. Primary Payer Code = F.
41	Federal Black Lung (BL) Program. Primary Payer Code = H.
42	Veterans Administration (VA). Conditional billing does not apply. Primary Payer Code = I.
43	Disabled beneficiary under age 65 with an LGHP. Beneficiary must have Medicare Part A entitlement (enrolled in Part A) for this provision to apply. Primary Payer Code = G.
44	Amount provider was obligated/required to accept from a primary payer as payment in full due to contract/law when that amount is less than charges but higher than amount actually received. An MSP payment may be due. Note: When applicable, this VC is reported in addition to MSP VC.
47	Any Liability Insurance. Requires OC 02 with date of accident/injury. Primary Payer Code = L. If filing for a Conditional Payment, report with Occurrence Code 24.

a	Enter the amount provider received from primary payer toward Medicare-covered charges on claim
b	If requesting conditional payment, enter zeros (00.00)
c	If no payment or reduced payment was received due to failure of filing a proper claim with primary payer, enter amount provider would have received had it filed a proper claim with primary payer.

Note-

Primary Payer Codes Primary Payer codes are not reported by the provider via electronic submission of a MSP claim. Primary Payer codes are applied to the claim upon transfer to the Fiscal Intermediary Standard System (FISS) based on the corresponding electronic data reported. Primary Payer Codes of A to L (except C) must match MSP VC reported on claim. For example, MSP VC 12 = Primary Payer Code A, etc.

FISS Codes: Fiscal Intermediary Standard System 

FISS Code	FISS Code Description	MSP VC
A	Working Aged with EGHP	12
B	ESRD with GHP in 30-month coordination period	13
C	Conditional Payment	Any
D	No-Fault including Automobile/other insurance	14
E	Workers’ Compensation (WC)	15
F	Public Health Service (PHS) or other federal agency	16
G	Disabled with LGHP	43
H	Federal Black Lung (BL) Program	41
I	Veteran’s Administration (VA)	42
L	Liability	47
Z	Medicare	None

The Remarks field (UB-04 FL 80) contains the following two-digit explanation code used for conditional claims.

Code	Description	Acceptable with VC(s)
BE	Benefits are exhausted. Always requires date benefits were exhausted in MM/DD/YY format. Bill conditionally when no payment received from primary payer and claim’s DOS is prior to exhaustion date. *No-Fault states should use PE; not BE. Note: Automobile No-Fault states should not use this code on automobile accident claims. See code PE below.	12, 13, 14, 15, 41, 43
CD	Charges applied to co-payment, coinsurance or deductible.	12, 13,14, 43
DA	120 days have passed since the primary payer was billed. Always requires date primary payer was billed in MM/DD/YY format. Report OC 24 with date insurance denied. *For VC 47, provider must have withdrawn claim with liability.	14, 15, 41, 47*
DP	Delay in payment from liability insurer. Report OC 24 with date insurance denied. See OC 24 above.	47
FG	Beneficiary did not follow guidelines of their primary health plan. Only used for out of network, untimely filing or no prior authorization. Always requires statement as to which of these guidelines was not followed.	12, 13, 15, 43
LD	Response received from liability insurer stating they are not responsible for Claim.	47
NB	Not a covered benefit. Report OC 24 with date insurance denied. See OC 24 above.	12, 13, 14, 15, 41, 43
PC	Pre-existing condition. Report OC 24 with date insurance denied. See OC 24 above.	12, 13, 43
PE	*No-Fault (also known as PIP) has been exhausted toward medical expenses. Always requires date benefits were exhausted in MM/DD/YY format. Provider must have copy of PIP on file. Bill conditionally when no payment received from primary payer and claim’s DOS is prior to exhaustion date.	14
PP	Beneficiary paid by liability insurer. Used only for conditional claims involving liability insurance payments to the beneficiary where the provider is not expecting any payment from the beneficiary. Report OC 24 with date insurance denied. See OC 24 above. Note: May not be used for medical payment insurance payments to the beneficiary (VC 14). Providers are required to pursue those dollars.	47

Patient Relationship Codes

UB04 Field Locator 59A, B, C

Code	Relationship Description
1	Spouse
18	Self
19	Child
20	Employee
21	Unknown
39	Organ Donor
40	Cadaver Donor
53	Life Partner
G8	Other Relationship

Note- Automobile No-Fault states include Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, North Dakota, New Jersey, New York, Pennsylvania, and Utah. Puerto Rico, a U.S. commonwealth, is also No-Fault.

Related Articles:

UB04 Condition Codes List

List of Revenue Codes in Medical Billing

Type of Bill (TOB) Codes List