Ub40 form 2026

See details

4.8 out of 5

145 votes

The document outlines the implementation of a new voluntary reporting requirement for clinical trial claims submitted to Medicare, effective April 1, 2008. Providers are instructed to include an 8-digit clinical trial registry number on claims for services provided in qualified clinical trials. This initiative aims to enhance tracking of Medicare payments and improve the relevance of research for Medicare beneficiaries, as recommended by the Institute of Medicine and supported by CMS policies.

Here's how it works

01. Edit your ub40 form uk online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send ub40 form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out ub40 form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the ub40 form in the editor.
Begin by entering the 8-digit clinical trial number in the designated field. This is crucial for identifying services provided during clinical trials.
Ensure you include Value Code D4 along with the clinical trial number on your claim. This should be placed in Form Locators 39-41.
For institutional claims, add the ICD-9 diagnosis code V70.7 and Condition Code 30 to complete this section accurately.
If submitting a professional claim, remember to prefix the clinical trial registry number with 'CT' in Field 19 of Form CMS-1500.

Start using our platform today to streamline your ub40 form completion for free!

See more ub40 form versions

We've got more versions of the ub40 form form. Select the right ub40 form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2008	4.8 Satisfied (145 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

ub40 document

How to get UB-04 form from hospital Ub40 form pdf Printable ub40 form Ub40 form download UB-04 form field descriptions UB-04 form download Sample UB-04 form How to fill out ub40 form