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A UB-04 is not the itemized bill

A UB-04 (also called a CMS-1450) is the institutional claim a hospital or facility sends to a health plan. It is built for the insurer: revenue codes, procedure codes, condition codes, and the total the facility wants the plan to process.

An itemized statement is the patient-facing list: each date, a description, the code, the units, and the charge. You can put that list next to an explanation of benefits. A UB-04 is a useful backup when the statement is still a one-line balance. It is not a substitute for the line list.

What to ask for

  1. Ask patient financial services for an itemized statement with dates, codes, units, and charges.
  2. If they only offer a summary, ask whether they can also send the UB-04 that went to the plan.
  3. Keep both next to the EOB. Pay from the provider statement only when the patient share matches.

This is educational. A hospital’s form names differ. It is not a determination about your claim.

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Is This Bill is not a law firm, medical provider, or billing advocate. This is educational software. It can misread documents. You are responsible for what you send and what you pay.

UB-04 and an itemized hospital bill | Is This Bill