To get a UB-04 from a hospital, ask the hospital’s patient billing office (or medical records / health information management department) in writing for a copy of the claim form it filed for your dates of service; under HIPAA, billing and claims records are part of your record, and the hospital must act on your request within 30 days.
The UB-04, also called the CMS-1450, is the claim form hospitals and other facilities use to bill Medicare, Medicaid and private insurers. It lists the revenue codes, procedure codes, diagnosis codes, dates and charges for your stay or visit. Patients usually need it to file their own claim with a secondary or out-of-network plan, to support a travel, accident or supplemental insurance claim, or to check a bill line by line.
Many patients ask for “an itemized bill” and receive a statement instead, or ask for a UB-04 and are told the hospital does not give them out. This guide explains exactly what to ask for, how to request it through the billing office or patient portal, what HIPAA says about timing and fees, and how the UB-04 differs from an itemized bill, an EOB and a good faith estimate.
Key Takeaways
- The UB-04 (CMS-1450) is the institutional claim form; the electronic version hospitals actually transmit is the X12 837I.
- HHS lists billing records, payment records and claims records as part of the designated record set you have a right to access under HIPAA.
- The hospital must act within 30 calendar days, with one extension of up to 30 more days if it tells you in writing why and when.
- Any fee must be reasonable and cost-based (certain labor, supplies and postage), or a flat fee of no more than $6.50 for electronic copies of electronic records.
- If you are uninsured or self-pay, ask for a good faith estimate before scheduled care; a bill at least $400 above it can be disputed within 120 days.
What a UB-04 Form Is
CMS describes the CMS-1450 (UB-04) as the standard paper claim form institutional providers use to bill Medicare Administrative Contractors, and it is also used with other payers. Users include hospitals, critical access hospitals, skilled nursing facilities, hospices, home health agencies, federally qualified health centers and rural health clinics. Inpatient rehabilitation facilities also bill on it; they report a CMG-based HIPPS code rather than therapy CPT codes, as explained in our inpatient rehabilitation billing guide.
The National Uniform Billing Committee (NUBC) maintains the code lists used on the form, including the revenue codes that describe each charge. Our guide to professional vs institutional claims explains why hospitals and doctors bill on different forms. Medicare requires hospitals to submit claims electronically on the 837I unless an exception under the Administrative Simplification Compliance Act applies, such as having fewer than 25 full-time equivalent employees. So the “UB-04” a patient receives is usually a printed image of the claim data, not the original paper form.
Key Fields You Will See
| Form locator | Field | Why it matters to you |
|---|---|---|
| FL 1 | Provider name | Confirms which facility billed |
| FL 3a | Patient control number | The account number to quote when you call |
| FL 4 | Type of bill | Shows facility type (for example inpatient or outpatient) and whether it is an original or corrected claim |
| FL 6 / FL 12 | Statement covers period / admission date | Check the dates match your stay |
| FL 42-47 | Revenue code, description, HCPCS/rate/HIPPS code, service date, units, total charges | The line-by-line charges |
| FL 50 | Payer name | Shows which insurer was billed first |
| FL 67 / 67A-Q | Principal and other diagnoses (ICD-10-CM) | Your insurer uses these to decide coverage |
| FL 69 / FL 70 | Admitting diagnosis / patient reason for visit | Reason you came in |
| FL 74 | Principal procedure (ICD-10-PCS, inpatient) | The main inpatient procedure |
| FL 76-79 | Attending, operating and other provider NPIs | Who treated you |
| FL 80 | Remarks | Notes from the billing team |
The form has 81 form locators in total. Physician services during the same stay are billed separately on the CMS-1500, so you may get separate bills from the hospital and from doctors.
How to Request a UB-04 From the Hospital
- Gather your details. Have the patient’s full name, date of birth, account or patient control number (from your statement), dates of service and insurance information ready.
- Contact the right department. Start with patient financial services (the billing office). If they cannot release it, send the request to health information management (medical records), which handles HIPAA access requests.
- Put it in writing. Use the hospital’s records-request form or patient portal message. Ask specifically for “a copy of the UB-04 (CMS-1450) claim submitted for dates of service [dates], plus an itemized statement of charges.” Writing creates a date that starts the 30-day clock.
- Check the patient portal. Many hospital portals have a billing section with statements and itemized bills. Some can produce claim copies on request; if yours does not, send a portal message to billing.
- Choose the format. Ask for a PDF by secure email or portal, or a paper copy by mail. HIPAA requires the hospital to provide the form and format you ask for if it is readily producible.
- Follow up. If you hear nothing within 30 days and received no written extension notice, contact the hospital’s privacy officer.
Worked Example: A Caregiver Request
Maria’s father had a three-day hospital stay. His supplemental hospital-indemnity policy asks for an itemized bill and the UB-04. Maria is listed as his HIPAA personal representative (she holds his healthcare power of attorney). She uses the hospital’s records-request form, attaches a copy of the power of attorney, lists the account number and admission and discharge dates, asks for the UB-04 and itemized statement as PDFs through the portal, and keeps a copy of the request. The hospital provides both within the 30-day limit. If Maria were not his personal representative, her father would need to sign an authorization or send a written, signed request directing the hospital to send the copies to her.
If your insurer already paid the claim, it also holds the claim data. Members can ask their plan for a copy of the claim, and Medicare beneficiaries can see processed claims in their Medicare account and on the Medicare Summary Notice.
Your HIPAA Right of Access
HHS states that designated record sets include medical records, billing records, and payment and claims records. That is why a UB-04 or the claim data behind it falls under your right of access. Our article on confidentiality in the medical field covers the other HIPAA rights that apply to billing records.
| Rule | What HIPAA requires |
|---|---|
| Deadline | Act on the request no later than 30 calendar days after receipt |
| Extension | One extension of up to 30 more days, only with a written notice of the reason and a completion date, sent within the first 30 days |
| Format | The form and format you request, including electronic, if readily producible; otherwise an agreed readable alternative |
| Fee | Reasonable, cost-based: only certain labor, supply and postage costs; or a flat fee up to $6.50 for electronic copies of records kept electronically |
| Sending to someone else | You can direct a copy to a third party with a written, signed request |
HHS notes that its fee guidance applies only as far as it is consistent with the court ruling in Ciox Health, LLC v. Azar, which affects copies sent to third parties at your direction. Copies you request for yourself are covered by the cost-based fee limits.
Do not accept “we do not release claim forms” as a final answer. Ask for the claim data in any readable format, cite your HIPAA right of access, and escalate to the privacy officer. You can also file a complaint with the HHS Office for Civil Rights.
UB-04 vs Itemized Bill vs Other Documents
| Document | Who creates it | What it shows | When you need it |
|---|---|---|---|
| UB-04 / 837I | Hospital or facility | Revenue codes, CPT/HCPCS, diagnosis and procedure codes, NPIs, total charges as billed to the payer | Filing your own claim, supplemental insurance, checking codes |
| Itemized bill | Hospital | Every charge by date, often with charge descriptions in plain language | Checking for duplicate or wrong charges |
| Patient statement | Hospital | Summary of charges, payments and the balance you owe | Paying the bill |
| CMS-1500 | Physicians and other professionals | Professional services, CPT codes, place of service | Doctor bills for the same stay |
| EOB | Your health plan | Allowed amount, plan payment, your cost share and adjustments | Matching what you owe to what the plan paid |
| Good faith estimate | Provider, for uninsured or self-pay patients | Expected charges for scheduled care | Before care, and for a bill dispute |
Physician offices give patients a superbill rather than a UB-04 when patients file their own claims; see our guide to the superbill in medical billing. The difference between billed charges and the plan’s allowed amount usually shows as a contractual adjustment, which in-network patients do not owe.
Self-Pay and Uninsured Patients: The Good Faith Estimate
Under the No Surprises Act, if you are uninsured or choose not to use insurance, providers must give you a good faith estimate when you schedule care at least 3 business days in advance, or when you ask for one. If the final bill from a provider is at least $400 more than that provider’s estimate, you can start the federal patient-provider dispute resolution process within 120 days of receiving the initial bill. The UB-04 or itemized bill is the evidence you compare with the estimate.
- Keep the good faith estimate and the date you received it.
- Request the itemized bill and UB-04 as soon as the first bill arrives.
- Compare line items, units and dates, and note any charge that was not on the estimate.
- Read our guide to patient balance rules after insurance adjustments before paying a disputed balance.
What to Check Once You Have the UB-04
Coverage dates and type of bill. Make sure FL 6 and FL 12 match your stay and FL 4 matches inpatient or outpatient care; observation stays are outpatient even if you stayed overnight.
Payer order. FL 50 should list your primary insurer first. If Medicare was billed before an employer plan that should be primary, see our guide to the Medicare Secondary Payer rule.
Units and duplicates. Compare units in FL 46 with the itemized bill and ask about any line you do not recognise.
If the insurer denies the claim, the hospital’s billing team should correct and resubmit or appeal it; patients can also file their own appeal with the plan. Our overview of the medical claim appeal process explains the levels and deadlines.
Run a hospital, SNF or other facility and want clean UB-04 and 837I claims that hold up when patients and payers review them? Talk to Steady Medical Billing’s billing team.
Frequently Asked Questions
Can a patient get a copy of the UB-04 from the hospital?
Yes. HHS lists billing, payment and claims records as part of the designated record set, so you can request the UB-04 or its claim data in writing under your HIPAA right of access.
How long does a hospital have to send my UB-04?
Under HIPAA’s right-of-access rule, the hospital must act within 30 calendar days of receiving your request. It may take one extension of up to 30 more days if it tells you in writing, within the first 30 days, why and when it will respond.
Can the hospital charge for a copy of the UB-04?
It may charge only a reasonable, cost-based fee covering certain labor, supplies and postage, or a flat fee of no more than $6.50 for electronic copies of records kept electronically.
Is a UB-04 the same as an itemized bill?
No. The UB-04 is the claim the hospital sent to the payer, with revenue codes, diagnosis and procedure codes and provider NPIs. An itemized bill lists every charge by date for the patient. Ask for both when you need to file or check a claim.
What if I am uninsured and the bill is higher than my estimate?
If the bill from a provider is at least $400 more than that provider’s good faith estimate, you can start the federal patient-provider dispute resolution process within 120 days of receiving the initial bill.
