Wiki CHAMPVA Billing for PHP - Need Guidance on UB-04 Requirements

[sandikoch44]

I’m looking for help from anyone experienced with billing CHAMPVA for Partial Hospitalization Program (PHP) services using the UB-04 form.

We’re receiving denials with the following codes:

• CO16 – Claim/service lacks information or has submission/billing error(s)
• M44 – Missing/incomplete/invalid condition code
• M45 – Missing/incomplete/invalid occurrence code(s)
• M49 – Missing/incomplete/invalid value code(s) or amount(s)

We’ve tried resubmitting with different condition, occurrence, and value codes, but the denials remain the same.

Does anyone know:

• Which UB-04 fields CHAMPVA requires for PHP?
• The correct condition, occurrence, and value codes?

Any insight, examples, or resources would be greatly appreciated!