New provider-based billing reimbursement policy goes into effect June 1

In alignment with industry standards, we’re updating our provider-based billing reimbursement practices.

What’s changing?

Effective June 1, we’ll no longer separately reimburse for clinic fees or any other fees associated with space used to provide E/M services, when billed on a UB-04 facility claim, regardless of the office being located on the hospital campus and/or using the hospital TIN.

This update will apply to all commercial and Medicaid lines of business for in- and out-of-network providers and facilities (excluding RHC and FQHC), regardless of reimbursement methodology.

What do you need to know?

We’ve published a new provider-based billing policy to support you in understanding:

  • What’s included in both non-facility and facility reimbursement rates
  • How these rates apply to a claim based on the place of service (POS) code
  • The conditions under which a claim will be denied

You should continue to bill the most appropriate place of service (POS) code for services rendered in your practice setting.