UB-04 Patient Discharge Status Code 66: Discharged/transferred to a Critical Access Hospital (CAH)

Overview

Patient Discharge Status Code 66 indicates that the patient was discharged or transferred to a Critical Access Hospital (CAH) ^[1]. A Critical Access Hospital is a small, rural facility designated by the Centers for Medicare & Medicaid Services (CMS) to provide limited inpatient and outpatient services, typically with 25 or fewer acute care beds. Code 66 is used on the UB-04 claim form in Field 17 (Patient Discharge Status) to document that the patient’s care was continued at a CAH after discharge from the current facility ^[1]. This code is distinct from other transfer codes such as 61 (swing bed), 62 (inpatient rehabilitation facility), or 63 (long-term care hospital) ^[1]. The UB-04 claim form is used by acute inpatient hospitals, acute outpatient hospitals, and other institutional providers when submitting paper claims to payers like MassHealth ^[2]. Proper use of code 66 ensures accurate tracking of patient movement and appropriate reimbursement for the transferring facility.

When to Use

Code 66 should be used when a patient is discharged from an acute care hospital, skilled nursing facility, or other inpatient setting and is directly transferred to a Critical Access Hospital for continued inpatient care ^[1]. The transfer must be to a facility that meets CMS’s CAH designation criteria, including location in a rural area and provision of 24/7 emergency services. This code applies only when the receiving facility is a CAH; if the patient is transferred to a CAH with a planned acute care hospital inpatient readmission, code 94 should be used instead ^[1]. Code 66 is not appropriate for transfers to other types of hospitals (e.g., short-term general hospitals, psychiatric hospitals, or rehabilitation facilities) or to non-hospital settings such as skilled nursing facilities or home health ^[1]. The code is also used when a patient is discharged from a hospital-based swing bed to a CAH, as swing beds are distinct from CAH status ^[1]. Providers should verify the receiving facility’s CAH certification before assigning code 66 to avoid billing errors.

Step-by-Step Claim Example

A patient is admitted to a general acute care hospital for pneumonia. After stabilization, the physician determines the patient requires continued inpatient care but can be managed at a smaller rural facility. The patient is transferred to a Critical Access Hospital located 30 miles away. On the UB-04 claim form for the initial hospital stay, the billing staff enters the following:

• Field 17 (Patient Discharge Status): Code 66 ^[1].
• Field 12 (Patient Discharge Hour): Enter the hour of discharge (e.g., 14 for 2:00 PM).
• Field 13 (Patient Discharge Date): Enter the date of transfer (e.g., 01/15/2025).
• Field 14 (Type of Admission): Code 1 (Emergency) or appropriate code.
• Field 15 (Source of Admission): Code 1 (Physician referral) or other applicable code.

The claim is submitted electronically or on paper if a waiver is approved ^[2]. The receiving CAH will bill separately for its services using its own UB-04 claim with appropriate admission source and type codes. The transferring hospital must retain documentation of the transfer order and CAH acceptance to support the use of code 66 ^[1].

Common Mistakes & Audit Red Flags

One frequent error is using code 66 when the patient is transferred to a facility that is not a Critical Access Hospital, such as a short-term general hospital or a skilled nursing facility ^[1]. Another mistake is confusing code 66 with code 61 (swing bed) or code 62 (inpatient rehabilitation facility) when the receiving facility is actually a CAH with swing beds or a distinct rehabilitation unit ^[1]. If the transfer is part of a planned acute care readmission, code 94 must be used instead of code 66 ^[1]. Auditors look for mismatches between the discharge status code and the receiving facility type; for example, using code 66 but the receiving facility is not listed as a CAH in CMS records can trigger a denial or recoupment. Providers should also ensure that the discharge date and hour are accurate, as discrepancies may indicate a non-covered transfer. Finally, failing to document the medical necessity for transfer to a CAH can lead to audit scrutiny, especially if the patient could have been discharged home or to a lower level of care.

Related Codes/Fields

The following table lists related patient discharge status codes that are commonly used alongside code 66 on the UB-04 claim form. All codes are from the Noridian patient status code list ^[1].

Code	Meaning	Notes
01	Discharged to home or self-care (routine discharge)	Most common discharge code
02	Discharged/transferred to a short-term general hospital for inpatient care	For non-CAH acute hospitals
61	Discharged/transferred to a hospital-based Medicare approved swing bed	Distinct from CAH transfer
62	Discharged/transferred to an inpatient rehabilitation facility (IRF)	Includes rehab distinct part units
63	Discharged/transferred to a Medicare certified long term care hospital (LTCH)	For long-term acute care
64	Discharged/transferred to a nursing facility certified under Medicaid but not Medicare	For Medicaid-only nursing homes
65	Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit	For mental health facilities
66	Discharged/transferred to a critical access hospital (CAH)	Subject of this article
94	Discharged/transferred to a CAH with a planned acute care hospital inpatient readmission	Use when readmission is planned

Field 17 on the UB-04 claim form is where the patient discharge status code is entered ^[2]. Accurate completion of this field is essential for correct payment and claims processing.

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References

[1] Noridian Patient Status — https://med.noridianmedicare.com/web/jea/topics/claim-submission/patient-discharge-status-codes

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download