Stanford Med · Unit 5B Medicine·Day shift·Mon · 9:42 AM

Disposition library (UB-04-grounded)

Where patients can go from inpatient · one entry per UB-04 Patient Discharge Status Code
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Discharge mapDispositions (UB-04)Post-acute servicesLogisticsNeeds × coverageResource hubInsurance plans
Every discharge ends in one of these settings. The list is grounded in NUBC UB-04 Patient Discharge Status Codes, the billing taxonomy every US hospital already uses, so Throughline's disposition vocabulary matches the encounter record. Layered care (Home Health, Home Infusion, Home DME, Hospice overlay, Outpatient PT) lives in the separate Post-acute services library — those are orthogonal to the setting.
UB-04 01
Home / self-care
Home / community

Patient returns home. Layered services (HH, infusion, DME, RPM, outpatient PT) attach orthogonally via the Services library.

Typical duration
Indefinite
Time to place
Same day
Owns referral
Hospitalist + RN (no external referral required for HOME itself; services route through CM)
Documents
Discharge summary · Med rec sheet · Follow-up appt
When to consider
  • ●Baseline functional status restored (or supported by caregiver)
  • ●Outpatient follow-up booked within 7 days
  • ●Any skilled need handled by an attached service (not by setting)
Eligibility
  • ADLs independent or supported by caregiver
  • Safe home environment
  • Med regimen manageable (with or without home pharmacy / DME service)
Coverage at a glance
Medicare FFS
Encounter bills UB-04 01; outpatient visits per plan
Medicare Advantage
UB-04 01; supplemental SDOH benefits per plan
Medicaid
UB-04 01; HCBS waivers may fund layered services
Commercial
UB-04 01; outpatient + layered services per plan
Risk if missedReadmit if outpatient appointment isn't scheduled in 7d.
UB-04 02
Transfer to another acute hospital
Receiving acute hospital

Patient hand-off to another acute care facility (tertiary escalation, network rebalancing, specialty unavailable).

Typical duration
Continuous (next facility's LOS)
Time to place
Hours (emergent) to 1–2 days (planned)
Owns referral
Hospitalist + House Supervisor + Case Manager
Documents
EMTALA transfer form (when applicable) · Receiving MD acceptance · Records / imaging packet · Transport order at correct acuity
When to consider
  • ●Specialty service unavailable here (advanced cardiac, transplant, burn center, NICU/PICU)
  • ●EMTALA appropriate-transfer obligation
  • ●Capacity rebalancing within health system
  • ●Patient choice / out-of-network situation requiring transfer
Eligibility
  • Receiving facility acceptance (MD-to-MD + bed available)
  • Stable enough for transport at the chosen acuity level
  • Transfer form signed + medical records package ready
Coverage at a glance
Medicare FFS
DRG transfer rules apply · receiving hospital gets next DRG
Medicare Advantage
Plan-specific authorization for inter-facility transfer
Medicaid
Covered when medically necessary · state-specific rules
Commercial
PA required for non-emergent transfer · EMTALA for emergent
Risk if missedCare continuity gap; EMTALA violation risk if emergent transfer is delayed.
UB-04 03
Skilled Nursing Facility (SNF)
Post-acute facility

Short-term skilled nursing or rehab in a Medicare-certified SNF; not synonymous with long-term custodial nursing home care.

Typical duration
7–30 days
Time to place
24–72h (bed + auth)
Owns referral
Case Manager
Documents
SNF referral packet · Auth approval · PT/OT eval + transfer note
When to consider
  • ●Cannot tolerate 3h/day of rehab (use SNF over IRF)
  • ●Skilled need but unsafe at home alone
  • ●Reconditioning after CHF, sepsis, ortho, stroke
Eligibility
  • Medicare: 3-night qualifying inpatient stay (waived for some MA plans)
  • MA: per plan rules — many waive 3-day
  • Skilled need daily (PT/OT, nursing, IV)
Coverage at a glance
Medicare FFS
Days 1–20 fully covered; 21–100 with daily copay (42 CFR §409.30)
Medicare Advantage
Per plan; PA required; often shorter benefit window
Medicaid
Long-term custodial coverage; short-term skilled per state
Commercial
Per plan; PA + tiered network
Risk if missedBed lost over weekend; auth window misses; patient occupies acute bed.
UB-04 04 / 64
Custodial / Medicaid Nursing Facility
Nursing facility

Long-term custodial or supportive care. NF = Nursing Facility; not short-term skilled SNF rehab. Includes long-term memory care units (Medicaid-funded). UB 04 = Medicare-certified NF; UB 64 = non-Medicare-certified NF.

Typical duration
Indefinite
Time to place
Weeks (Medicaid pending = main delay)
Owns referral
Social Worker
Documents
Medicaid LTC app · Bed-hold agreement · Guardianship if applicable
When to consider
  • ●No safe community option
  • ●Family unable to provide 24h care
  • ●Custodial-level need only (no daily skilled need — else SNF)
Eligibility
  • Medicaid LTC pending or approved (income/asset test)
  • Functional + cognitive assessment
Coverage at a glance
Medicare FFS
Not covered (custodial)
Medicare Advantage
Not covered
Medicaid
Covered if Medicaid LTC eligible (income/asset test); UB-04 64 for non-Medicare-certified
Commercial
LTC insurance only
Risk if missedMonths of super-stranded acute bed days while Medicaid processes.
UB-04 21
Court / law enforcement custody
County jail medical / state custody

Patient discharged to law enforcement custody (jail medical, court-ordered transfer). Bills as UB-04 21. Rare but procedurally distinct from AMA.

Typical duration
—
Time to place
Hours
Owns referral
Hospitalist + Hospital security + Risk Management
Documents
Custody hold documentation · Transfer paperwork · Medical clearance
When to consider
  • ●Patient under custodial hold throughout admission
  • ●Court order specifies transfer back to detention
  • ●Forensic psychiatric commitment
Eligibility
  • Custody documentation in chart
  • Receiving facility medical clearance
  • Court order if applicable
Coverage at a glance
Medicare FFS
Suspended during incarceration (Medicare-Incarceration rule)
Medicare Advantage
Same — Medicare benefits suspended
Medicaid
Suspended in most states (some keep enrollment open)
Commercial
Plan-specific
Risk if missedCustody / chain-of-evidence break; liability exposure.
UB-04 43
Federal hospital (VA / military)
VA Medical Center / DoD facility

Transfer to a VA or DoD facility — most common for veterans whose primary care + complex management lives in the VA system (Palo Alto VA, SF VA).

Typical duration
Varies (continuous)
Time to place
1–3 days (VA bed availability is the gate)
Owns referral
Case Manager + VA liaison + Hospitalist
Documents
VA enrollment verification · Transfer acceptance from receiving VA MD · Records release
When to consider
  • ●Veteran with established VA primary care wanting transfer back
  • ●VA accepts the patient and bed available
  • ●Insurance / VA eligibility documented
Eligibility
  • VA enrollment verified
  • Receiving VA bed acceptance + transport order
  • Records release per 38 USC
Coverage at a glance
Medicare FFS
VA covers full cost once accepted; no Medicare bill
Medicare Advantage
VA covers
Medicaid
VA covers
Commercial
VA covers
Risk if missedPatient self-discharges or accepts costly community placement.
UB-04 61 / 62
IRF / ARU (UB 61 / 62)
Inpatient rehab facility

Intensive rehab — minimum 3h/day across PT/OT/SLP for ≥5 days/week. UB 61 = distinct-part rehab unit (hospital-based ARU); UB 62 = free-standing IRF.

Typical duration
10–21 days
Time to place
48–96h (auth-limited)
Owns referral
Case Manager + Physiatrist consult
Documents
IRF-PAI initial assessment · Auth packet · Therapy tolerance documentation
When to consider
  • ●Stroke, TBI, hip fx, spinal cord, major multi-trauma
  • ●Patient tolerates and benefits from 3h/day therapy
  • ●Two-discipline rehab need (PT + OT or PT + SLP)
Eligibility
  • CMS 60% rule diagnosis (stroke, hip fx, etc.) or documented need
  • Patient must tolerate 3h/day or be expected to soon
  • Physician supervision daily
Coverage at a glance
Medicare FFS
Part A; PA via CMS criteria (60% rule)
Medicare Advantage
PA required; many plans direct to SNF first
Medicaid
Covered per state; auth required
Commercial
PA + medical necessity review
Risk if missedPatient deconditions; loses IRF candidacy.
UB-04 63
Long-Term Care Hospital (LTCH / LTAC)
LTCH hospital

Medically complex patients with average LOS > 25 days (vent weaning, complex wounds).

Typical duration
25–60 days
Time to place
72h–7 days
Owns referral
Case Manager + Pulmonary/Critical Care
Documents
Auth packet · Vent settings + wean plan · Wound documentation
When to consider
  • ●Prolonged ventilator weaning
  • ●Complex multi-system management beyond SNF capability
  • ●Daily MD oversight + RT required
Eligibility
  • Medicare interrupted-stay rules
  • Complexity score per LTCH criteria
Coverage at a glance
Medicare FFS
Part A; LTCH PPS rate
Medicare Advantage
PA + medical necessity review
Medicaid
State-dependent
Commercial
PA + case rate negotiation
Risk if missedPatient occupies ICU bed needing complex care unavailable on floor.
UB-04 65
Inpatient behavioral / psych
Stand-alone IPF, psych unit, or SUD residential program

Inpatient psychiatric facility (IPF) or substance-use residential treatment.

Typical duration
5–14 days (acute psych) · 30–90 days (SUD residential)
Time to place
Hours (crisis) to 2–3 days (planned)
Owns referral
Social Worker + Psychiatry consult + Case Manager
Documents
Psychiatric eval + safety screen · ASAM assessment (SUD) · Behavioral health PA
When to consider
  • ●Acute psychiatric admission (suicidality, psychosis, danger to self/others)
  • ●Substance use disorder requiring 24-hr supervised withdrawal
  • ●Step-down from medical-psychiatric stabilization
Eligibility
  • Inpatient psychiatric criteria per InterQual / MCG
  • ASAM Level 3.7 / 4 for SUD residential
  • Voluntary OR civil commitment per state statute
Coverage at a glance
Medicare FFS
Part A covers IPF (190-day lifetime limit at free-standing); SUD residential separate benefit
Medicare Advantage
Must follow Medicare parity rules · plan-specific PA
Medicaid
Covered with state IMD waivers; often carved-out behavioral health managed care
Commercial
Mental Health Parity Act applies · plan PA required · usually carved-out benefit
Risk if missedBoarding in ED / med-surg bed for days; safety risk; payer denial for non-psych bed-day.
UB-04 66
Critical Access Hospital (CAH)
Critical Access Hospital

Transfer to a CAH — small (≤25 beds) rural hospital with cost-based Medicare reimbursement. Rare in Bay Area but used for rural outlying areas (Sonoma West, far Solano).

Typical duration
Continuous (CAH 96-hour ALOS rule)
Time to place
Hours to 1 day
Owns referral
Hospitalist + Case Manager + CAH liaison
Documents
Transfer acceptance · Records / imaging packet · Transport order
When to consider
  • ●Geographic proximity to patient's home/family in rural area
  • ●Sub-acute care needed without IRF/LTCH complexity
  • ●Patient transfer from urban tertiary back to community CAH
Eligibility
  • CAH bed available + accepting MD
  • CAH 96-hour ALOS feasible
  • Patient stable for the transfer distance
Coverage at a glance
Medicare FFS
Cost-based reimbursement at CAH; DRG transfer rules apply
Medicare Advantage
Per plan
Medicaid
Covered when medically necessary
Commercial
PA + medical necessity
Risk if missedPatient stays in urban acute bed unnecessarily.
UB-04 50
Hospice · home
Home / hospice agency

Comfort-focused care at home with hospice agency for life-limiting illness.

Typical duration
6 months or less prognosis
Time to place
Same day with capacity
Owns referral
Social Worker + Palliative team
Documents
Hospice election · Two MD certifications · POLST
When to consider
  • ●Prognosis ≤ 6 months
  • ●Goals of care shift to comfort
  • ●Family willing + able to provide caregiving
Eligibility
  • Two MD certs (referring + hospice medical director)
  • Election of hospice benefit (Medicare/MA/Medicaid)
Coverage at a glance
Medicare FFS
Hospice benefit covers MD, RN, MSW, chaplain, meds, DME (42 CFR §418)
Medicare Advantage
Carved back to Original Medicare for hospice
Medicaid
Hospice benefit per state
Commercial
Per plan; some carve-out
Risk if missedPatient dies in acute setting; family / staff trauma.
UB-04 51
Hospice · Inpatient Unit (GIP)
Hospice IPU

Inpatient hospice for symptom management when home is not appropriate.

Typical duration
1–14 days typical
Time to place
Same day with bed
Owns referral
Palliative team + Social Worker
Documents
Hospice election · GIP criteria documentation
When to consider
  • ●Uncontrolled symptoms requiring 24h skilled management
  • ●Imminent death + family unable to manage at home
Eligibility
  • Hospice eligible + GIP criteria met
Coverage at a glance
Medicare FFS
Hospice GIP rate
Medicare Advantage
Carved back
Medicaid
Per state
Commercial
Per plan
Risk if missedPatient suffers; family distress; acute bed occupied.
no UB-04
Assisted Living Facility (ALF)
Assisted living facility

Supportive housing with ADL help; not skilled. No UB-04 code — encounter bills as 01 (Home). Tracked here as a planning-only setting.

Typical duration
Long-term
Time to place
1–2 weeks
Owns referral
Social Worker
Documents
ALF intake forms · Funding verification
When to consider
  • ●ADL help needed but not skilled care
  • ●Self-pay or LTC insurance or HCBS waiver
Eligibility
  • ADL eval
  • Funding source
Coverage at a glance
Medicare FFS
Not covered
Medicare Advantage
Not covered (some supplemental benefits)
Medicaid
Some HCBS waivers cover ALF in select states
Commercial
LTC insurance only
Risk if missedPatient pulled toward unnecessary SNF for funding reasons.
no UB-04
Memory care / dementia unit
Memory care facility

Secure assisted-living unit for dementia / cognitive impairment. No UB-04 code — encounter bills as 01 (Home).

Typical duration
Long-term
Time to place
1–4 weeks (waitlists common)
Owns referral
Social Worker
Documents
Cognitive eval · Funding verification · Guardianship if applicable
When to consider
  • ●Moderate–severe dementia with wandering risk
  • ●Family unable to safely supervise 24h
  • ●No skilled need (else SNF first)
Eligibility
  • Cognitive assessment + safety screen
  • Funding source (private pay, LTC insurance, Medicaid waiver)
Coverage at a glance
Medicare FFS
Not covered (custodial)
Medicare Advantage
Generally not covered
Medicaid
HCBS waiver in some states; LTC nursing home if available
Commercial
LTC insurance only
Risk if missedPatient super-stranded; legal/funding pending; weeks of avoidable days.
no UB-04
Medical respite / shelter
Medical respite / shelter

Recuperative care for patients experiencing homelessness — community-based.

Typical duration
2–4 weeks
Time to place
1–7 days (capacity-limited)
Owns referral
Social Worker + Housing navigator
Documents
Respite intake · Behavioral screen
When to consider
  • ●Homeless or housing-insecure
  • ●Recovery requires more than shelter but not skilled SNF
Eligibility
  • Medical respite program intake criteria
  • Behavioral stability per program
Coverage at a glance
Medicare FFS
Not covered (some PACE programs)
Medicare Advantage
Some plans offer supplemental SDOH benefit
Medicaid
Some Medicaid managed-care plans contract with respite
Commercial
Generally not covered; charity/grant-funded
Risk if missedPatient discharged to street; readmission within days; ethical/legal exposure.
UB-04 05
Inpatient cancer / children's hospital
Specialty inpatient hospital

Transfer to a specialty cancer hospital (e.g. UCSF Helen Diller, Stanford Cancer Center IP) or children's hospital (Lucile Packard Children's, UCSF Benioff). Bills as UB-04 05.

Typical duration
Varies (continuous; receiving hospital LOS)
Time to place
Hours (emergent) to 1–3 days (planned)
Owns referral
Hospitalist + Specialist + Case Manager
Documents
Transfer acceptance from receiving MD · Specialty consult notes · Records / imaging packet · Transport order at correct acuity
When to consider
  • ●Inpatient chemotherapy / specialty oncology service unavailable here
  • ●Pediatric subspecialty (neonatal, peds CV, peds onc) not on site
  • ●Bone marrow transplant / CAR-T center referral
Eligibility
  • Receiving facility acceptance + bed available
  • Stable enough for transport at appropriate acuity
  • Insurance authorization for the specialty admission
Coverage at a glance
Medicare FFS
DRG transfer rules; receiving hospital bills next DRG
Medicare Advantage
Plan PA for inter-facility transfer
Medicaid
Covered when medically necessary; state-specific PA
Commercial
PA required; EMTALA for emergent
Risk if missedSpecialty care window closes; outcome decrements.
UB-04 07
Left Against Medical Advice (AMA)
Patient choice (typically home / unknown)

Patient self-discharges against clinical recommendation. Documentation + harm-mitigation paperwork required.

Typical duration
—
Time to place
Immediate
Owns referral
Attending + Risk Management notified
Documents
AMA form signed by patient + clinician witness · Documentation of capacity assessment
When to consider
  • ●Patient with capacity declines continued inpatient care
  • ●All efforts to negotiate + educate documented
Eligibility
  • Decisional capacity confirmed
  • AMA discussion + signed form completed
Coverage at a glance
Medicare FFS
Encounter bills UB-04 07; no SNF benefit triggered
Medicare Advantage
Per plan; potential reduced coverage of subsequent readmit
Medicaid
Per state
Commercial
Per plan
Risk if missedLiability if discharge wasn't documented as AMA when it was.
UB-04 20
Expired
Mortuary services + bereavement coordination

Patient deceased during inpatient stay. UB-04 codes 20 (in facility), 21 (in medical facility off-site), 22 (place unknown).

Typical duration
—
Time to place
—
Owns referral
Bereavement + Risk Management + Decedent Affairs
Documents
Death pronouncement note · Death certificate · Coroner notification if applicable
When to consider
  • ●Death pronounced by attending or hospitalist
Eligibility
  • —
Coverage at a glance
Medicare FFS
Encounter bills UB-04 20
Medicare Advantage
Encounter bills UB-04 20
Medicaid
Encounter bills UB-04 20
Commercial
Encounter bills UB-04 20
Risk if missed—
⚙How this screen works
Routes library defines the universe of possible discharge destinations
Inputs
What this screen reads
  • Clinical eligibility (six-pillar status + dx)
  • Payer plan + benefit window
  • Family / patient preference
  • Resource Hub capacity for matching kinds
Engine
What it computes
  • Filters routes by clinical eligibility per disposition criteria
  • Filters by payer (e.g. SNF needs 3-night stay for Medicare unless waived)
  • Surfaces required documents + time-to-place per route
Outputs
What it writes / routes
  • Cockpit disposition card consumes this for primary + alt suggestion
  • Resource matcher uses this for upstream filtering
  • Route choice locks logistics + needs flow
Refresh trigger
When it updates
  • Edits to src/lib/library/routes.ts (e.g. new payer policy)
  • Payer rule updates (e.g. MA plan SNF waiver)
Partners involved:Naviguide (SNF/ARU referral)WellSky CarePort (alt SNF directory)Hospice partners (Mission Hospice, Hospice by the Bay)
Demo data · no PHI · mocked Epic + payer endpoints