Completing the UB-04 Claim Form – Introduction Practice Test

The field FL 47 captures the amount billed for the services grouped by the revenue code on that line. In the UB-04 form, each line item uses a revenue code to categorize the type of service or department, and FL 47 holds the total charges for all those services under that specific code for that encounter. It’s a monetary figure tied to the service category, not to the patient’s name, a service date, or a diagnosis code—those details come from other fields. For example, if a line shows a revenue code for radiology services, FL 47 will show the total charge billed for those radiology services on that line.