In accordance with correct coding methodology, UnitedHealthcare determines reimbursement based on coding which specifically describes the services provided. S9088 is considered informational only as it pertains to the place of service and not the components of the specific service(s) provided, and S9083 is a global code which does not provide encounter level specificity.
UnitedHealthcare will not reimburse S9088. In addition, S9083 will not be reimbursed in specific states. The State Application Table identifies the states where S9083 will not be reimbursed. Additional states will be added and the policy will be updated.
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The American Medical Association Current Procedural Terminology (CPT®) Professional Edition gives the following instruction for code selection: "Select the name of the procedure or service that accurately identifies the service performed."
According to Centers for Medicare and Medicaid Services (CMS), Place of Service (POS) Codes Database: "Place of service codes and descriptions should be used on professional claims to specify the entity where service(s) were rendered."
Consistent with CPT® and CMS, physicians and other healthcare professionals should report the evaluation and management, and /or procedure code(s) that specifically describe the service(s) performed. Additionally, a place of service code should be utilized to report where service(s) were rendered.
The following codes are not reimbursable for Urgent Care services: