Office-based procedure reimbursement
To encourage the use of office-based procedures, Priority Health has increased the number of procedures eligible for a site-of-service payment differential.
Reimbursement includes both the current physician professional component and a facility component equal to the National CMS Ambulatory Surgery Center fee.
Eligible office-based procedures
Increased reimbursement applies to procedures that previously did not have a resource-based relative value scale (RBRVS) site-of-service payment differential. Get a copy of the updated office-based procedure fee schedule from your provider account representative, who can also help you with billing and payment questions. You may contact them directly or call the Provider Helpline.
Eligible providers
Physicians with standard Priority Health contracts are eligible for the reimbursement. Some unique physician-negotiated contracts may not allow for the office-based procedure reimbursement.
Accreditation required
Providers must be accredited to perform office-based procedures. If a provider lacks proper accreditation, Priority Health will take back payment for each office-based procedure claim.
Michigan Quality Improvement Consortium (MQIC)-acknowledged accreditation organizations include:
- American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)
- Accreditation Association for Ambulatory Health Care (AAAHC)
- The Joint Commission (TJC)
- American Osteopathic Association Health Care Facilities Accreditation (AOA HCFA)
