VC-F --UB-04 Value codes and descriptions

Code	Name	Description	Note
01	Most Common Semi-private Rate	To provide for the recording of hospital's most common semi-private rate.	
02	Hospital Has No Semiprivate Rooms	Entering this code requires $0.00 amount.	
03		Reserved for national assignment.	
04	Professional Component Charges Which are Combined Billed	Code indicates the amount shown is the sum of the technical and professional charges, which are combined billed.	Medicare uses this information in internal processes and also in the CMS notice of utilization sent to the patient to explain that Part B coinsurance applies to the professional component. (Used only by some all inclusive rate hospitals.)
05	Professional Component included in Charges and also Billed Separate to Carrier	Amount shown is the combined billed charges (technical and professional); however the provider is submitting a separate professional bill to the health plan.	For use on Medicare or CHAMPUS bills and all Medicaid bills if state specifies need for this information.
06	Medicare Blood Deductible	Total cash blood deductible.	If appropriate, enter the Part A or Part B blood deductible amount. (To report other than the blood deductible, that is to report the program deductible, see Value Codes (FL39-FL41) A1, B1, and C1.)
07		Reserved for national assignment.