Overview
UB-04 value codes are two-character codes in Form Locators 39 through 41 of the UB-04 institutional claim that identify dollar amounts or quantities relevant to claim processing. Each value code pairs with a numeric amount in the adjacent "Amount" field, allowing the claim to communicate financial or quantitative information that affects adjudication. Up to 12 value code-amount pairs may be reported per claim.
Examples of value codes include: 01 (Most common semi-private room rate), 06 (Medicare blood deductible), 08 (Medicare lifetime reserve amount in first calendar year), 14 (Traditional Medicare Part A deductible), 22 (Surplus Medicaid), 30 (Pre-admission testing), 31 (Patient liability amount), 37 (Pints of blood furnished), 44 (Amount provider agreed to accept from primary payer — COB), 48 (Hemoglobin reading for dialysis), 50 (Physical therapy visits — quantity), 51 (Occupational therapy visits), 52 (Speech therapy visits), 57 (Amount deducted for non-covered charges), 62 (HH visits — Part A), and many others spanning benefit usage, coordination of benefits, patient responsibility, and service quantity reporting.
Value codes serve three broad purposes. First, they communicate patient benefit usage — how many covered days have been used, how much deductible has been met, lifetime reserve days consumed. Second, they support coordination of benefits — primary payer amounts, amounts agreed to accept, secondary payer processing inputs. Third, they report quantities relevant to specific service types — therapy visits, home health visits, pints of blood furnished, dialysis measurements.
The value code taxonomy is maintained by the National Uniform Billing Committee (NUBC) and is updated periodically. Payer-specific companion guides identify which value codes are required, which are conditional, and which are optional for their adjudication processes. Medicare has extensive value code requirements for inpatient, outpatient, and home health claims; commercial payers vary in value code usage but generally follow NUBC standards.
For RCM operations, value code assignment requires integration between patient accounting, utilization management, clinical documentation, and coordination-of-benefits systems. Common value codes (deductible amounts, patient liability, primary payer amounts) are typically automated based on benefit verification and prior payer output. Less common value codes (therapy visit counts, hemoglobin values, specific quantity reports) require manual data capture from clinical systems.
Denial and rejection patterns related to value codes include missing required value codes (payer rejects for incomplete claim), incorrect amounts (causing misadjudication), and inconsistency between value codes and other claim fields (e.g., therapy visit value code inconsistent with revenue code line counts). Patient accounting teams should monitor value code-related denials and coordinate with HIS configuration teams to ensure value code logic remains accurate, particularly as Medicare benefit parameters update annually (deductible amounts, coinsurance amounts, lifetime reserve mechanics).
Because value codes frequently carry financial amounts that map directly to patient liability, value code accuracy affects both payer reimbursement and patient billing. Errors in patient liability value codes can create either over-collection (billing patient more than appropriate) or under-collection (billing less than the actual liability), both of which create compliance and financial risk.
Industry benchmark
UB-04 value code slots: Form Locators 39–41 (up to 12 code-amount pairs). NUBC maintenance: annual updates with Medicare parameter refreshes.
Worked example
A Medicare inpatient claim reports value code 14 (Medicare Part A Deductible) paired with the deductible amount applicable to the benefit period. The claim also reports value code 06 (Medicare Blood Deductible) when applicable, value code 01 for semi-private room rate, and additional value codes as required for the specific stay. The payer uses value code amounts as adjudication inputs, calculating patient responsibility and benefit usage from the reported values.
Frequently asked questions — UB-04 Value Code (Form Locators 39–41)
How many value codes can appear on a UB-04?
Up to 12 value code-amount pairs across Form Locators 39–41.
Do value codes always carry dollar amounts?
No. Some value codes carry quantities (therapy visits, days, pints of blood) or clinical measurements (hemoglobin). The adjacent amount field holds whatever numeric value the code represents.
Are value codes payer-specific?
The codes are NUBC-standardized but payer usage varies. Medicare has extensive value code requirements; commercial payers use fewer codes. Payer companion guides specify requirements.
Disclaimer
This glossary entry is operational reference for revenue-cycle and medical-billing professionals. It is not legal, clinical, or contractual advice. Industry benchmarks cite named public sources where available; always verify against the current guidance from the authority body before relying on a number in a contract, policy, or compliance filing.