What Is the Difference Between the UB-92 and HCFA-1500 Forms?

The primary difference between the two forms is related to who uses them – medical facilities (UB-92) vs individual practitioners (HCFA-1500). The UB-92 medical claim form is used by medical institutions, such as hospitals, nursing facilities and other facility providers. The HCFA-1500 medical claim form is used by non-institutional health care service providers or medical professionals, such as individual doctors, nurses and therapists.

The UB-92 form was replaced by the UB-04 Form per the ruling of the National Uniform Billing Committee in 2005. The UB form is maintained by the NUBC, which is a voluntary committee that procures and develops data for claims and related transactions.

The primary difference between the UB and the HCFA-1500 forms is that the UB form is required for facility billing purposes. The form is filed by an assortment of institutions, including acute care facilities, stand-alone clinics, surgery centers, sub-acute facilities, home health care agencies, hospice organizations, and psychiatric, drug and alcohol treatment centers. The UB is a claim for Medicare Part A reimbursement of both inpatient and outpatient services to Medicare MAC’s and FI’s. The UB form is not used to file charges of physicians or individual medical providers. These charges are billed on the HCFA-1500 claim form.

The HCFA-1500 is the standard paper claim form used by medical suppliers and professionals to bill Medicare providers and Durable Medical Equipment Medicare Administrative Contractors. The HCFA-1500 must be submitted within one year from the date of service, and beneficiaries cannot be charged for filing or completing this claim.