Urgent care

Applies to:

All plans


Care provided at an urgent care center, instead of a hospital emergency room, when the patient needs immediate care to treat a non-life threatening illness or injury to limit severity and prevent complications.

Urgent care billing

Member benefits differ if the urgent care is received from a non-participating provider. HMO plan members must use a participating provider when in the service arear.

Bill services obtained in an urgent care setting as follows.

Hospital-based urgent care

UB-04: Rev Code 456 or 516 (whichever is appropriate) with corresponding E&M code*

1500: POS 22 with corresponding E&M code

Independent urgent care

CMS-1500: POS 20 with corresponding E&M code*

*Member liability will be applied if applicable