UNITEDHEALTHCARE – Place of Service and Professional/Technical Component Policy

September 21, 2011 – Effective in the fourth quarter of 2011, following CMS’ guidelines, UnitedHealthcare will begin to recognize an Ambulatory Surgical Center (ASC) as a facility POS (Place of Service) when reported on the CMS 1500 claim form.  POS 24 is a freestanding facility, other than a physician’s office, where surgical and diagnostic services are provided on an ambulatory basis.  This means that physicians and other health care professionals who submit claims for services provided at an ASC that involve both a professional and technical component will no longer be reimbursed for both components, but only for the professional component.
 
The following three policies will be updated according to this POS change.
 
Professional/Technical Component
 
UnitedHealthcare will reimburse the interpreting professional provider only for the professional component of services provided in a facility when:

  1. the services are subject to the professional/technical component or
  2. the services have both professional and technical components

This is because the facility where the services are performed is reimbursed for the technical component associated with these services.   Under current policy, interpreting providers were reimbursed for both the professional and technical component as well as the facility was reimbursed for the technical component.
 
Laboratory Rebundling Policy
 
Providers will not be allowed reimbursement for the following laboratory codes for services submitted with facilityPOS 24 on aCMS 1500 claim form.

  • Laboratory codes assigned a PC/TC Indicator 3 (Technical component only codes); and
  • Laboratory codes with a PC/TC Indicator 9 (the PC/TC concept does not apply)

Under the current policy, when performed in an ASC, UnitedHealthcare has reimbursed providers for these services.  Under the new policy, providers will not be reimbursed for these services but the ASC facility will continue to be reimbursed for these codes.
 
Contrast and Radiopharmaceutical Materials Policy
 
The Contrast and Radiopharmaceutical Materials Policy does not allow separate reimbursement to professional providers for contrast and radiopharmaceutical materials, the technical component part of the global service of an imaging or nuclear medicine procedure, when the imaging procedure is submitted with a facility POS 24.
 
The ASC facility will continue to be reimbursed for these materials.
 
More information on this new policy can be found in United Healthcare’s Network Bulletin, September 2011 Supplement on their website, http://unitedhealthcareonline.com

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