Value Codes
These slides cover how to complete the value code portion of the CMS-1450 and 837I forms.
Loop 2300 HI/FLs 39-41
| Value Code and Value Code Amount | Source |
|---|---|
| Enter dollar or unit amounts. Value codes are 2 alphanumeric digits, and each value allows up to 9 numeric digits (0000000.00). | NUBC |
When reporting value amounts, negative amounts aren't allowed except in FL 41. Whole numbers or non-dollar amounts are right justified to the left of the dollars and cents separator. When reporting values in cents, refer to specific codes for instructions.
There are 4 lines of data, line a through line d. Use FLs 39a through 41a before 39b through 41b. If the claim shows more than 1 value code for a billing period, show codes in ascending numeric sequence.
Note: Medicare Secondary Payer (MSP) claims require a value code.
More on Loop 2300/FLs 39-41
Examples of commonly used value codes include:
- 12 – Working aged beneficiary spouse with Employer Group Health Plan (EGHP)
- 13 – ESRD beneficiary in a Medicare Coordination Period with an EGHP
- 14 – No-fault, including auto/other insurance
- 15 – Workers’ Compensation (WC)
- 16 – Public Health Service (PHS) or other federal agency
- 17 – Operating Outlier amount
- 41 – Black Lung (BL)
- 42 – Veteran Affairs
- 43 – Disabled beneficiary under age 65 with a Large Group Health Plan (LGHP)
- 44 – Obligated to Accept as Payment in Full (OTAF)
- 47 – Any liability insurance
- 80 – Covered days
- 81 – Noncovered days
- 82 – Coinsurance days
- 83 – Lifetime Reserve (LTR) days
Note: Value Codes 80–83 are used for Home Health, SNF, or hospice services, covering days, visits, and related care services.
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