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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

August 2018

Billing for Facility-Based Urgent Care


To ensure proper payment and member cost sharing, it is important to bill facility-based urgent care services correctly. When billing with the revenue code 516 for commercial urgent care services rendered in a facility location, the corresponding professional evaluation and management service should be reported with the appropriate CPT procedure code and place of service code 23 (Emergency Room – Hospital).

Note that this method of billing does not apply to providers contracted and marketed as an “Urgent Care Center” in Harvard Pilgrim’s provider directory; those providers should bill with place of service code 20 (Urgent Care Facility). For more information, please refer to the commercial Urgent Care Payment Policy and the updated commercial Emergency Care Payment Policy.

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PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator