In medical billing, the Claim Frequency Type Code (also known as the Submission Reason Code) indicates the status of the claim in the billing lifecycle (e.g., is it a new bill, a correction, or a cancellation?).
This code is found in Loop 2300, Segment CLM05-3 of the electronic 837 file. On paper forms, it corresponds to Box 22 (CMS-1500) or the third digit of the Type of Bill (UB-04).
These are the standard codes used for Professional (CMS-1500) and most Institutional billing.
| Code | Name | Description | When to Use |
| 1 | Original Claim | This is the very first claim submitted for a specific encounter. | Use for new claims or when billing a secondary payer for the first time. |
| 7 | Replacement / Corrected | This claim replaces a previously processed claim. | Use to fix a mistake (e.g., wrong code, missing modifier) on a claim the payer already accepted. You must include the original claim ID (ICN). |
| 8 | Void / Cancel | This claim cancels a previously processed claim entirely. | Use if you billed the wrong patient or a duplicate claim was processed in error. This eliminates the claim from the payer's history. |
These codes are primarily used by hospitals, nursing homes, and home health agencies (UB-04 forms) for patients who are hospitalized for long periods. They tell the payer "this is just part of the bill."
| Code | Name | Description |
| 2 | Interim - First Claim | The first bill in a series for a continuous stay (e.g., the first month of a long hospital stay). |
| 3 | Interim - Continuing Claim | A bill for a subsequent period of the same stay (e.g., the second or third month). |
| 4 | Interim - Last Claim | The final bill for the stay; signals that the patient has been discharged. |
These are used in specific administrative scenarios.
| Code | Name | Description |
| 5 | Late Charge(s) Only | Used to bill only for items that were forgotten on the original bill. (Note: Most modern payers prefer you use Code 7 to replace the full claim rather than submitting late charges separately). |
| 9 | Final Claim (HHA) | Specifically used for Home Health Agency PPS Episodes to indicate the final bill. |
| 0 | Non-Payment / Zero Claim | Used when you do not expect payment (e.g., billing only to update the patient's deductible or for denial tracking purposes). |
Most commonly used:
Code 1 (Original): Use this for almost all your initial submissions.
Code 7 (Replacement): Use this to fix the "Missing Diagnosis" or "Wrong Modifier" denials we discussed. (Remember to include the Payer's original Claim ID in the "Original Ref Number" field).
Code 1 vs. 7 for Denials: If a claim was rejected as "Unprocessable" (e.g., Invalid Patient ID), you usually treat it as Code 1 (Original) because the payer never technically "accepted" it into their system to be replaced.