Correct coding reminders
We’re offering reminders of correct coding practices to keep in mind when completing a UB-04 claim, as well as when billing for services rendered at an ambulatory surgical center. Because errors are common in these billing scenarios, we want to support our provider partners in billing appropriately to enable claims to be priced and paid properly.
Billing UB-04 claims
It’s important to follow industry standard billing guidance when completing a UB-04 form or its electronic equivalent, the 837 institutional claim transaction. As a reminder, facility providers should not bill both medical and behavioral health services together on the same claim. In addition, to identify members discharged/transferred to a psychiatric hospital or a psychiatric distinct part unit (DPU) of a hospital, it’s mandatory to include discharge status code 65 on the claim.
You can find general billing guidance pertaining to the UB-04 form or the electronic 837 institutional claim transaction in our CarePartners of Connecticut Provider Manual.
Billing for ambulatory surgical center services
When billing for ambulatory surgical center facility services on a CMS-1500 form or an 837 professional claim transaction, please remember to include the modifier SG in order to apply the correct benefit configuration (e.g., cost sharing, deductible).
Please keep in mind that this modifier is applicable only to claims from ambulatory surgical centers for facility charges; it is not billable on claims for physician or other qualified health care professional services. Modifier SG is intended for use as an informational modifier to be appended to any facility service rendered by an ambulatory surgical center to identify it as an ambulatory surgical center service.
When applicable, always submit a modifier that reduces the fee schedule/allowable amount in the primary modifier position, and modifier SG in the secondary position.
*Editor’s note: updated ambulatory surgical center services section for additional clarity on 3.20.2025.*