Questions for Dr. Stern
About Your Urgent Care Center
55. We would like to begin using S9088 and are currently checking reimbursement. My question for use of this code is this: if we use it, do we have to use Place of Service code 20 (Urgent Care Facility)?
As you know, payment for this new code is still very spotty, but some urgent care centers report payments of up to $50 in some states. Also, in Florida and California, some payors may be using this code as the "flat-rate" ("case-rate") fee, so using this code may create some problems with some payors, if you have not negotiated a flat rate fee. I would use this code sparingly with payors, until you are sure of how it will be treated by each payor in Florida. You do not want to create a cash flow problem and a multiple rebilling issue by using it on too many claims. POS-20: This will be carrier-specific. Medicare (and many MCOs) crosswalk POS-20 to POS-11, so the computer never processes the POS-20 in its algorithms. Anyhow, POS-20 seems the most likely to work. Note: there are still a few MCOs that have not updated their software and can not process POS-20. My suggestion: use POS-20. If they reject the code, continue to code S9088 (for non-Medicare) as this may help to build a U&C fee schedule in your state. I hope that this helps. Please contact me with questions.
