Urgent Care Billing: S9083 vs S9088, Medicare Insights
Urgent care billing can become quite complex and different codes can make complications even worse, such as the S9083 and S9088. Understanding when these codes should and should not be applied works for reimbursement as well payer requirements. This blog will define the differences that exist between codes S9083 and S9088, show their interaction with E/M codes, and finally explain Medicare billing for urgent care centers.
S9088: When to Use S9083 with S9088
The “services provided in an urgent care center (list in addition to code for service)” clause under HCPCS code S9088 is described as an add-on code to be billed with an E/M code (99201-99215), recognizing an increased cost of providing care in an urgent care setting beyond that found in a primary care setting.
Verify payer contracts for exceptions, because some payers bundle this code into their payments. Note: This code is not applicable to Medicare services, which means it cannot be billed to Medicare patients.
S9083: Global Fee for Urgent Care
The HCPCS code S9083 is a “case rate” code meaning an all-inclusive, single flat fee covers the visit, regardless of services delivered. Simplified billing; however, not a good model for an urgent care center treating moderate to severe cases.
Most private payers will bundle everything under their payment for S9083. Your urgent care treats more complicated cases such as IV hydration, laceration repairs, and fracture management; thus, this model limits profit on more extensive care. This case rate model is the most beneficial for clinics treating minor ailments such as colds.
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