HCFA-1500 Box 18 - Hospitalization Dates Related to Current Services

On the HCFA-1500 form, Box 18 is used to report hospitalization dates related to the current services rendered. This includes the admission and/or discharge dates if the claim involves any procedures or services provided during a hospital stay.

Tip: Enter the admission and discharge dates in MMDDYYYY format. If only the admission date is known (e.g., the patient is still hospitalized), enter just the admission date. Likewise, enter the discharge date only if applicable.

In our example below, we entered '05/02/2025' as the admission date and '05/04/2025' as the discharge date.

In the X12 837 transaction, Box 18 is represented by two separate DTP segments in the 2300 Claim Information Loop:

• DTP*435 – Admission Date
• DTP*096 – Discharge Date

Key X12 837 Details:
  • DTP01: Date Qualifier (435 = Admission, 096 = Discharge)
  • DTP02: Date Format Qualifier (D8 = Single Date)
  • DTP03: Date Value (e.g., 20250502)

Sample 837P (5010) – 2300 Claim Information

Note: Box 18 should only be completed when the claim is directly related to a hospitalization. The admission and discharge dates are submitted as two separate DTP segments using the D8 (single date) format—never as a date range.

For additional information on the X12 837 standard, please refer to the official implementation guides published by X12.

HCFA-1500 Form Box Locations

• HCFA-1500 Box 0 - Carrier Block
• HCFA-1500 Box 1 - Insurance Type
• HCFA-1500 Box 1a - Insured's ID Number
• HCFA-1500 Box 2 - Patient's Name
• HCFA-1500 Box 3 - Patient's Birth Date and Sex
• HCFA-1500 Box 4 - Insured's Name
• HCFA-1500 Box 5 - Patient's Address
• HCFA-1500 Box 6 - Patient Relationship to Insured
• HCFA-1500 Box 7 - Insured's Address
• HCFA-1500 Box 8 - Reserved For NUCC Use
• HCFA-1500 Box 9 - Other Insured's Name
• HCFA-1500 Box 9a - Other Insured's Policy or Group Number
• HCFA-1500 Box 9b - Reserved For NUCC Use
• HCFA-1500 Box 9c - Reserved For NUCC Use
• HCFA-1500 Box 9d - Insurance Plan Name or Program Name
• HCFA-1500 Box 10 - Is Patient's Condition Related To
• HCFA-1500 Box 10d - Claim Codes
• HCFA-1500 Box 11 - Insured's Policy Group or FECA Number
• HCFA-1500 Box 11a - Insured's Date of Birth and Sex
• HCFA-1500 Box 11b - Other Claim ID
• HCFA-1500 Box 11c - Insurance Plan Name or Program Name
• HCFA-1500 Box 11d - Is There Another Health Plan
• HCFA-1500 Box 12 - Patient's or Authorized Person's Signature
• HCFA-1500 Box 13 - Insured's or Authorized Person's Signature
• HCFA-1500 Box 14 - Date of Current Illness, Injury, Pregnancy (LMP)
• HCFA-1500 Box 15 - Other Date
• HCFA-1500 Box 16 - Dates Patient Unable to Work in Current Occupation
• HCFA-1500 Box 17 - Name of Referring Provider or Other Source
• HCFA-1500 Box 17a - Other ID
• HCFA-1500 Box 17b - NPI
• HCFA-1500 Box 18 - Hospitalization Dates Related to Current Services [You are Here]
• HCFA-1500 Box 19 - Additional Claim Information
• HCFA-1500 Box 20 - Outside Lab Charges

Grab a sample of the HCFA-1500 claim form here - HCFA 02/12 Claim Form