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Providers Should Begin Including ICD Indicator on UB-04 Paper Claim Forms

September 10, 2014

UB-04 paper claims received on or after September 22, 2014, must include the ICD indicator “9” when they include a diagnosis code in the Diagnosis Code fields (Boxes 67 – 67Q) and/or Principal Procedure Code and Date fields (Boxes 74 – 74E). In anticipation of this requirement, providers should start including the ICD indicator “9” on claims immediately.

No ICD indicator is required if the claim is submitted without a diagnosis code and/or procedure code. Claims received on or after September 22, 2014, that do not include the ICD indicator “9” with a diagnosis code and/or a procedure code will be returned via the Resubmission Turnaround Document (Form 65-1).

For more information about the ICD indicator requirement, please see the Claim Form Updates page of the Medi-Cal website.