Hospital Name Here
Disposition Status Tool
Addressograph/Patient
Identifiers Here
Select one of the following. NOTE: Some choices require corroboration in the discharge plan of care.
 01 Discharged to home or self-care
(routine discharge)
Includes: Home on oxygen; court/law enforcement; residential care
facility; home with durable medical equipment (DME) services; foster
care; and partial hospitalization
Excludes: Home on oxygen under the care of a home health
agency
 02xDischarged or transferred to another shortterm general hospital for inpatient care
 03xDischarged or transferred to a Medicare
certified skilled nursing facility (SNF)
Includes: Transfer to Medicare certified SNF for skilled care,
including a rehab unit within a skilled nursing facility
Excludes: Transfers to swing bed to receive skilled nursing services
(see 61); non-certified nursing facility (see codes 04 and 64);
nursing home to receive custodial care (see 04)
 04 Discharged or transferred to intermediate care
facility (ICF)
Includes: State certified assisted living facility; and nursing facilities
with neither Medicare nor Medicaid certification (for custodial care)
 05 Discharged or transferred to another type of
institution (including distinct parts)
Includes: Discharged to partial hospitalization; children's hospital;
cancer facility; and chemical dependency treatment facility not part
of a psychiatric hospital or psychiatric distinct part unit of a hospital
Excludes: Skilled nursing facility; and rehabilitation unit or facility
 06 Discharged or transferred to home under care
of organized home health service organization
Includes: Discharge to home with follow-up by visiting nurses, home
attendant, nursing aides, or certified nursing attendant; and home
health services with DME or oxygen
Excludes: Home health services provided by a durable medical
equipment (DME) supplier or a home intravenous (IV) provider for
home IV services (see code 08 or 01)
 20 Expired (or did not recover – Christian Science
patient)
 30 Still patient
Includes: Leave of absence days or interim bills
 40 Expired at home
For use only on Medicare and CHAMPUS claims for hospice care
 41 Expired in a medical facility (e.g. hospital, SNF,
ICF, or free standing Hospice)
Hospice claims only
 42 Expired - place unknown
Hospice claims only
 43 Discharged or transferred to a federal health
care facility
Includes: VA hospital, VA nursing facility, psychiatric unit within a VA
facility
 50 Hospice home
Includes: Transfer from an inpatient hospital to a hospice
 51 Hospice - medical facility
Includes: Transfer from an inpatient hospital to a hospice
 61 Discharged or transferred within this institution
to a hospital-based Medicare approved swing bed
Includes: Discharged or transferred to SNF level of care within a
hospital’s approved swing bed
 62 Discharged or transferred to an inpatient
rehabilitation facility including distinct-part units
of a hospital
 63 Discharged or transferred to a long-term care
hospital
 07 Left against medical advice (AMA) or patient
discontinued care
Long-term care hospital Medicare provider number ranges are
between xx2000 – xx2299.
The patient discharge status code for leaving AMA (code 07)
supercedes other code choices.
 64 Discharged or transferred to a nursing facility
certified under Medicaid but not certified under
Medicare
 09 Admitted as an inpatient to this hospital
For use on Medicare outpatient claims in situations where a patient
is admitted before midnight on the third day following the day of an
outpatient diagnostic service or service related to the reason for the
admission, the outpatient services are considered inpatient. Use
this code only for services that began more than three days earlier
or were unrelated to the reason for admission such as observation
following outpatient surgery, which results in admission.
 65 Discharged or transferred to a
psychiatric hospital or psychiatric distinct part
unit of a hospital
Effective 1/1/05
 66 Discharged or transferred to a Critical Access
Hospital (CAH)
Effective 1/1/06
Signature_________________________________________________________________ Date:_________________________________________
MO-06-21-HOSP GEN June 2006 This material was prepared by Primaris, the Medicare Quality
Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS),
an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.