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UB2 - Ub92 Data Segment

The UB2 segment contains data necessary to complete UB92 bills specific to the United States. Realms outside the US are referred to chapter 16. Only Uniform Billing fields that do not exist in other HL7 defined segments appear in this segment. For example, Patient Name and Date of Birth are required; they are included in the PID segment and therefore do not appear here. Uniform Billing field locators are provided in parentheses ( ). The UB codes listed as examples are not an exhaustive or current list; refer to a UB specification for additional information.

HL7 Attribute Table - UB2 - UB92 Data Segment
Seq# DataElement Description Must Implement Flags Cardinality Length C.LEN Vocabulary DataType
UB2
1 00553 Set ID - UB2 [0..1] [1..4] SI
2 00554 Co-Insurance Days [0..1] [1..3] ST
3 00555 Condition Code [0..7] CWE
4 00556 Covered Days [0..1] [1..3] ST
5 00557 Non-Covered Days [0..1] [1..4] ST
6 00558 Value Amount & Code [0..12] UVC
7 00559 Occurrence Code & Date [0..8] OCD
8 00560 Occurrence Span Code/Dates [0..2] OSP
9 00561 Uniform Billing Locator 2 [0..2] [1..29] ST
10 00562 Uniform Billing Locator 11 [0..2] [1..12] ST
11 00563 Uniform Billing Locator 31 [0..1] [1..5] ST
12 00564 Document Control Number [0..3] [1..23] ST
13 00565 Uniform Billing Locator 49 [0..23] [1..4] ST
14 00566 Uniform Billing Locator 56 [0..5] [1..14] ST
15 00567 Uniform Billing Locator 57 [0..1] [1..27] ST
16 00568 Uniform Billing Locator 78 [0..2] [1..2] ST
17 00815 Special Visit Count [0..1] [1..3] NM

UB2-1: Set ID - UB2 (SI) 00553

Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.

UB2-2: Co-Insurance Days (ST) 00554

Definition: This field contains the number of inpatient days exceeding defined benefit coverage. In the US, this corresponds to Uniform Billing form locator 9. This field is defined by CMS or other regulatory agencies.

UB2-3: Condition Code (CWE) 00555

Definition: This field contains a code reporting conditions that may affect payer processing; for example, the condition is related to employment (Patient covered by insurance not reflected here, treatment of non-terminal condition for hospice patient). The code in this field can repeat up to seven times to correspond to Uniform Billing form locators 24-30. Refer to User-defined Table 0043 - Condition Code in Chapter 2C, Code Tables, for suggested values. Refer to a UB specification for additional information. This field is defined by CMS or other regulatory agencies.

UB2-4: Covered Days (ST) 00556

Definition: This field contains Uniform Billing field 7. This field is defined by CMS or other regulatory agencies.

UB2-5: Non-Covered Days (ST) 00557

Definition: This field contains Uniform Billing field 8. This field is defined by CMS or other regulatory agencies.

UB2-6: Value Amount & Code (UVC) 00558

Definition: This field contains a monetary amount and an associated billing code. The pair in this field can repeat up to twelve times to represent/contain UB92 form locators 39a, 39b, 39c, 39d, 40a, 40b, 40c, 40d, 41a, 41b, 41c, and 41d. This field is defined by CMS or other regulatory agencies.

UB2-7: Occurrence Code & Date (OCD) 00559

Definition: The set of values in this field can repeat up to eight times. Uniform Billing fields 32a, 32b, 33a, 33b, 34a, 34b, 35a, and 35b. This field is defined by CMS or other regulatory agencies.

UB2-8: Occurrence Span Code/Dates (OSP) 00560

UB2-9: Uniform Billing Locator 2 (ST) 00561

Definition: This field contains an occurrence span code and an associated date. This field can repeat up to two times to represent/contain Uniform Billing form locators 36a and 36b. This field is defined by CMS or other regulatory agencies.

Definition: The value in this field may repeat up to two times.

UB2-10: Uniform Billing Locator 11 (ST) 00562

Definition: The value in this field may repeat up to two times.

UB2-11: Uniform Billing Locator 31 (ST) 00563

Definition: Defined by CMS or other regulatory agencies.

UB2-12: Document Control Number (ST) 00564

Definition: This field contains the number assigned by payor that is used for rebilling/adjustment purposes. It may repeat up to three times. Refer Uniform Billing field 37.

UB2-13: Uniform Billing Locator 49 (ST) 00565

Definition: This field is defined by CMS or other regulatory agencies. This field may repeat up to twenty-three times.

UB2-14: Uniform Billing Locator 56 (ST) 00566

Definition: This field may repeat up to five times.

UB2-15: Uniform Billing Locator 57 (ST) 00567

Definition: Defined by Uniform Billing CMS specification.

UB2-16: Uniform Billing Locator 78 (ST) 00568

Definition: This field may repeat up to two times.

UB2-17: Special Visit Count (NM) 00815

Definition: This field contains the total number of special therapy visits.