UnitedHealthcare Discontinues of Reimbursement for Two Codes

January 2019 ~

Beginning April 1, UnitedHealthcare (UHC) commercial plans, UnitedHealthcare Oxford and UnitedHealthcare Community Plan in some states will revise their policies to no longer reimburse HCPCS codes S9083 and S9088.

UHC instructs: in place of billing S9083 (Global Fee Urgent Care Center) or S9088 (services provided in an urgent care center), the applicable CPT® codes should be billed for the evaluation and management and/or procedure services you performed. When reporting where services were rendered, a place of service code must be included. The insurer notes that charges for S9083 or S9088 billed on a claim will be denied.

NOTE: As with all UnitedHealthcare Community Plan policies, other factors affecting reimbursement may supplement, modify or in some cases supersede this policy. These factors include but are not limited to federal and/or state regulatory requirements, physician or other provider contracts, and/or the member’s benefit coverage documents.

Unless otherwise noted, these reimbursement policies apply to services reported using the CMS-1500 or its electronic equivalent, or its successor form.

According to the insurer, UHC Community Plan reimbursement policies don’t address all issues related to reimbursement for services rendered to our members, such as the member’s benefit plan documents, our medical policies and the UnitedHealthcare Community Plan Administrative Guide or Care Provider Manual. Meeting the terms of a particular reimbursement policy is not a guarantee of payment. Likewise, retirement of a reimbursement policy affects only those system edits associated with the specific policy being retired. Retirement of a reimbursement policy is not a guarantee of payment. Other applicable reimbursement and medical policies and claims edits will continue to apply. If there’s an inconsistency or conflict between the information in this provider notification and the posted policy, the provisions of the posted reimbursement policy prevail.

The reimbursement policy for these Medicaid plans are posted on UHCprovider.com, under Non-Covered Codes and Covered Codes Policy, Professional — Reimbursement Policy.

Source(s): UnitedHealthcare Network Bulletin January 2019;