Which form is used to bill facility charges in a hospital setting?

• A. CMS 1500
• B. UB-04
• C. 837P
• D. 277CA

Answer: (B)

Facility charges are the costs tied to the hospital’s services itself, such as room, board, nursing, labs, and other inpatient or outpatient care. Hospitals submit these charges on the UB-04 form (CMS-1450), which is the standard institutional billing form. The UB-04 is designed for facility billing and uses revenue codes to identify the department or service (for example, room and board, laboratory, or radiology) and lines for charges, payments, and adjustments. By contrast, the CMS 1500 form is used to bill professional services—the clinician’s services—rather than the hospital’s facility charges. Its electronic counterpart for professional claims is 837P, not used for facility charges. The 277CA is a claim status request/response form, not a billing form. So, for hospital facility charges, the UB-04 is the appropriate form.