MedicaidBilling CodesHigh impact
UB04 Billing Addendum to Non-Covered Charges
Maryland Medicaid·MD·Provider Transmittal
Effective date
Jun 26, 2023
We identified it
Jun 20, 2026
Summary
Maryland Medical Assistance Program (Medicaid) issued mandatory updates to UB04 claim submission procedures for non-covered charges, effective immediately. Providers must now correctly report service units in FL 46 (including both covered and non-covered), total charges in FL 47, and line-item non-covered charge amounts in FL 48 for each revenue code. This policy supersedes all prior billing guidance on these form locators and requires immediate compliance to avoid claim denials during RAC audits.
Action Required
Immediately: Billing team must update UB04 claim submission procedures to comply with new form locator requirements. (1) FL 46 - Service Units: Ensure all revenue codes report total service units including BOTH covered and non-covered services (except revenue code 0001). (2) FL 47 - Total Charges: Report total charges for each revenue code for the billing period, including all days determined medically necessary and not medically necessary by Maryland Department of Health. (3) FL 48 - Non-Covered Charges: Report line-item non-covered charge amounts for each revenue code on lines 1-22 when non-covered service units are reported in FL 47. Verify billing software calculates FL 48 (non-covered charges) and subtracts this amount from FL 47 (total charges) automatically. Review the example UB04 claim provided in the policy document to validate proper format and values. Educate all billing and revenue cycle staff on these requirements immediately. Test claims with non-covered room and board charges and ancillary services before submission. Non-compliance will result in claim denials during Department Recovery Audit Contractor (RAC) audits. Contact Denise James, Chief for Division of Hospital Services at (410)767-1939 or the Institutional Provider Relations Hotline at (410)767-5503 option 3 with questions.