How To Bill Urgent Care Centers | Description & Billing & Reimbursement
Urgent care centers provide services for patietns with conditions that don’t require hospital admission. Below we explain what urgent care centers are and how to bill services provided in these centers.
1. What Are Urgent Care Centers?
Urgent care centers deliver outpatient medical care for patients with conditions that do not require normal hospital admission.
Urgent care centers are mainly used for treating patients with chronic/and or acute illnesses or injuries. They require immediate attention but are not life-threatening. 24/7 walk-ins or unscheduled visits are possible for patients who need immediate care.
These types of facilities also serve non-emergency conditions that include:
- Health services for women, men, and children;
- Vaccinations and immunizations;
- Warts destruction;
- H1N1 or swine flu;
- Flu or fever;
- Asthma (mild);
- Animal or insect bites;
- Wound care;
- Drainage/incision of abscesses
- Ear infections;
- Skin rashes;
- Sore throat;
- Minor injuries and cuts;
- Twisted ankles or other joints; and/or
2. How To Bill Urgent Care
Services provided in an Urgent Care Center are similar to service levels provided to patients who visit a physician’s office. You can use CPT 99201 until CPT 99215 to report urgent care services.
Reimbursement is based on a flat rate method that combines al the procedures or services performed on that day.
Urgent care center services can also be reimbursed on the level of service. They are usually categorized into three levels.
An example is BCBS of Florida. They use CPT 99201, CPT 99202, CPT 99211, and CPT 99212 as level one.
CPT 99203 and CPT 99213 are level two services, and level three are services described by CPT 99204, CPT 99205, CPT 99214, or CPT 99215.
3. Reimbursement Levels Of Urgent Care Centers
Below are the three levels often used for services provided in urgent care centers.
3.1 Triage Care/Minor Problems (Level 1)
These include E/M services to patients with no diagnostic tests.
3.2 Intermediate Care/Moderate Problems (Level 2)
These services include vaccines and injections together with E/M procedures.
3.3 Complex Care/Severe Problems (Level 3)
These include IV infusion, and sutures together with the provided E/M services.
4. What Is The Difference Between Urgent Care Facilities And Emergency Departments?
An emergency department is part of a hospital and provides patient care for critical conditions. Examples are:
- Suicidal attempts;
- Motor accidents;
- Heart attacks; or other
- Life-threatening conditions.
An Urgent Care Facility serves patients with conditions that need immediate attention but is considered non-emergency. According to CMS, a visit is normally short (less than twelve hours).
5. Can We Bill CPT 99281, CPT 99282, CPT 99283, CPT 99284, Or CPT 99285 For Urgent Care Centers?
No, it is not allowed to use these CPT codes for services provided in urgent care centers. These codes describe emergency services provided in hospitals (POS 23). You can only use the place of service code 20 (POS 20) for urgent care facilities.
6. Urgent Care Center CPT Code 99282
CPT code S9083 covers payments for a health provider who provided care for an injured or ill patient who needed immediate care at an urgent care center.
CPT S9083 is officially described by the CPT manual as: “Global fee urgent care centers.”
Report CPT code S9083 for the global fee (a consistent payment for similar services across all jurisdictions) collected by a health provider in an urgent care center.
The payment covers all the necessary services furnished after, during, or before the procedure.
6.2 When To Use CPT S9088
Report CPT code S9088 for all walk-in patients (that are unscheduled) in an urgent care center.
CPT S9088 could be billed to the urgent care centers for all unscheduled, walk-in patients. This code is not payable by Medicare or Medicaid insurance.
7. Can CPT Code 99050 And CPT Code 99058 Be Billed Together?
No, that is not possible. They are not paid separately because urgent care centers refer to an after-hours facility.
8. Can CPT Code 99211 Be Used For Urgent Care Centers?
Yes, that is possible if the patient comes for a blood pressure test, refills, B12 injections, or other services where a physician is not needed.
9. Is It Possible To Bill Postoperative Services?
That is impossible because postoperative services are not billed to patients or insurance. They are only billed if a patient is provided a service for a different reason within the global period of the surgery that was previously performed.
This is excellant information. Can you tell me if I can code S9083 and S9088 as a family practice provider who place of service is 11 but sees patient for urgent care issues. Due to our clinic being the only facility within 5 hour drive of the nearest ER or urgent care clinic.
We have a lot of tourist from the mainland visit Hana in Maui, HI and the insurance does not pay us because I cannot code emergency or urgent care codes.
Any advice on how I should code for this would be helpful.
Hi Terri, sorry for the late reply. We missed your question. You can ask your questions here: https://www.codingahead.com/ask-a-question/. We’ll make sure it will be answered within 48 hours.