Web Reference: Dec 12, 2025 · Condition Code 44 is a specific billing code used when a hospital’s Utilization Review (UR) committee determines an admitted patient does not meet the medical necessity for inpatient care under Medicare guidelines. Condition Code 44 will not affect payment. It will be used for monitoring purposes only to allow CMS and Quality Improvement Organizations (QIOs), to track and monitor these occurrences. Using the NUBC Condition Code 44 involves adding the code to a claim of a patient who was changed from inpatient to outpatient before the inpatient claim was submitted, because the hospital determined the services did not meet inpatient criteria.
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