78Condition CodeBeneficiary/Spouse Insurance
A newly covered Medicare service wasn't paid by the patient's HMO.
Related Beneficiary/Spouse Insurance codes
01The patient's condition is related to military service and coordinates with VA benefits.02The condition being treated is related to the patient's employment.03The patient has insurance coverage not otherwise reflected on this claim.04This claim is submitted for informational purposes only, typically because an HMO or managed care plan has already processed it.05A legal lien has been filed for recovery of the billed funds.07This admission treats a condition unrelated to the terminal illness of a patient enrolled in hospice.08The beneficiary declined to provide information about other insurance coverage they may have.09Neither the patient nor their spouse is currently employed.10The patient is employed, but no employer group health plan coverage exists.11The patient is disabled, and no large group health plan coverage exists.
Frequently asked questions
What does condition code 78 mean?
A newly covered Medicare service wasn't paid by the patient's HMO.
What category is condition code 78 in?
78 falls under the Beneficiary/Spouse Insurance category of UB-04 condition codes.
Descriptions sourced from CMS Medicare Claims Processing Manual. Always verify codes with authoritative sources before making billing decisions.