With the number of Urgent Care Centers on the rise since 2015, there were new codes added just to represent where the patient went. However, not all payers had a clear payment policy for those codes. When I used to work for the Urgent Care back in 2015-2016, this was a major billing issue I had to personally deal with.
Here is the most updated Payment policy for Urgent Care codes: S9088 and S9083:
Definition: S9088- the services provided in an urgent carte center
Definition: S9083- global fee urgent care centers
*CMS considers both of these codes as informational codes so there is no reimbursement for them.
According to MVP Health Care effective 12/01/2018 they will adopt reimbursement payment policy “based on the E/M code billed for the services”.
***Providers should bill an appropriate E/M code with a Place of service 20 (URGENT CARE)*** Unless the Urgent care is part of a hospital where the POS (place of service can be 22, outpatient hospital). Article 28 is not recognized by some payers, therefore to avoid unnecessary denials the providers should still bill POS 20.***