CurrentUnitedHealthcarePolicy 2025R5023A

UB04 inpatient readmission reimbursement

Defines UnitedHealthcare reimbursement rules for inpatient same-day, planned, and leave-of-absence readmissions billed on UB04 forms (or electronic equivalent) for Commercial and Individual Exchange products and all inpatient facilities.

Policy Summary

PayerUnitedHealthcare

PolicyUB04 inpatient readmission reimbursement

Policy CodePolicy 2025R5023A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionReport condition code B4 for unrelated same-day readmissions or combine planned readmissions within 30 days using occurrence span code 74 with leave dates.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30 daysplanned readmission window

B4required code for unrelated same-day

74occurrence span code

Inpatient Readmission Reimbursement Criteria

Inpatient readmission reimbursement criteria

Rules for combining or separately reimbursing readmissions:

Same-day readmissions for the same or related condition must be combined with the initial admission and reported on the same UB-04 claim form; not eligible for separate reimbursement.

Same-day readmissions for an unrelated condition are eligible for separate reimbursement only when reported with condition code B4 on the UB-04 claim; if not reported with B4, they are not eligible for separate reimbursement.

Planned readmission or leave of absence within 30 days of the initial admission must be combined with the initial admission and reported on the same UB-04 claim form with occurrence span code 74 showing the dates the leave began and ended.

Exclusions (policy does not apply)

Admissions for chemotherapy or immunotherapy treatment.

Policy Summary

PayerUnitedHealthcare

PolicyUB04 inpatient readmission reimbursement

Policy CodePolicy 2025R5023A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionReport condition code B4 for unrelated same-day readmissions or combine planned readmissions within 30 days using occurrence span code 74 with leave dates.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Billing and Code Reporting

Condition codes for same-day readmissionmixedCovered

B4	Condition code indicating unrelated same-day readmission eligible for separate reimbursement

Occurrence span codes for planned readmissionmixedCovered

74	Occurrence span code for reporting leave of absence dates for planned readmission

Planned readmission window

Planned readmission window30 days from the initial admission

Applies toPlanned readmissions and leave-of-absence readmissions to the same facility

Billing requirementMust be combined with the initial admission on the same UB-04 claim when within 30 days

Reporting codeUse occurrence span code 74 to report leave begin and end dates

Provider Billing and Documentation Actions

Documentation Required

Medical record review

Medical records may be requested to ensure UnitedHealthcare reimbursement guidelines have been followed. The medical record review process is consistent with CMS guidelines.

Billing Rule

Same-day unrelated readmission billing

Same-day readmissions for the same or related condition as the initial admission must be combined with the initial admission and reported on the same UB-04 claim form. If the same-day readmission is for a condition unrelated to the initial admission, it must be reported with condition code B4 on the UB-04 claim to be eligible for separate reimbursement.

Same-day unrelated readmission: report condition code B4 on UB-04 to seek separate payment.

Billing Rule

Planned readmission reporting

A planned readmission or leave of absence within 30 days of the initial admission must be combined with the initial admission and reported on the same UB-04 claim form using occurrence span code 74 to report the dates the leave began and ended.

Use occurrence span code 74 to report leave dates on the UB-04 when combining planned readmission/leave with the initial admission.

Key Definitions

Same Day Readmission

DefinitionAdmission to the same acute care hospital on the same day as the previous admission

Combination ruleSame-day readmissions for the same or related condition must be combined with the initial admission (not separately reimbursed)

Separate reimbursement conditionSame-day readmission for an unrelated condition may be eligible for separate reimbursement when reported with condition code B4

Planned Readmission / Leave of Absence

DefinitionAn intentional readmission within 30 days that is a scheduled part of the patient’s plan of care where the patient does not require hospital level of care; the facility may discharge and readmit the patient or place the patient on leave of absence

Combination requirementPlanned readmission/leave of absence within 30 days must be combined with the initial admission on the same UB-04 claim form

Reporting requirementReport occurrence span code 74 with leave begin and end dates on the UB-04 claim