LAC 40:I.2523. Required Information for Billing Inpatient Services

A. Itemization 1. Billing for hospital and other institutional type services must be submitted on a UB-92 Form as developed and implemented by the National Uniform Billing (UB-92) Committee. A copy of this form is on the last page of this Section. 2. Please itemize inpatient charges with the applicable UB-92 revenue codes. The use of all inclusive accommodation and ancillary revenue codes is not acceptable. These codes may contain services which are noncovered. 3. Invalid revenue codes which are not assigned or defined in the UB-92 manual are not allowed. 4. Sample UB-92 Form