According to UHC Commercial Plans May Reimbursement Policy Update:
Starting 08/01/2021 the new reimbursement policy will apply to E/M (99202-99215) codes. This policy applies to services billed on professional (HCFA-1500) form and UB 04 (facility) form.
This policy applies to services that are performed in POS 19 (Off Campus Outpatient Hospital) or POS 22 (On Campus Outpatient Hospital) without any additional medical surgical service on the same day of service by the same provider.
The E/M codes will be only reimbursed when billed with a POS (place of service) 11.
For Provider Based Facility Clinic visit with revenue code 051X:
Facility Claim (UB04) – provider based facility clinical visit services with a Revenue code 051X will not be separately reimbursed IF a coinciding Professional Claim (HCFA-1500) is billed and reported with POS 11 and/or billed with the same E/M codes (99202-99215).
When will this policy NOT apply?
When a provider performs E/M codes AND a medical surgical service ON THE SAME DOS, the professional and facility claim (if applicable) WILL NOT BE SUBJECT TO THE ABOVE POLICY.
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