Transcription of Provider Based Billing Policy, Professional and Facility
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Provider Based Billing Policy, Professional and Facility
Commercial Reimbursement Policy UB04 CMS 1500 2022R5022A Proprietary information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. RETIRED Provider Based Billing Policy, Professional and Facility IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed Based on the code or codes that correctly describe the health care services provided. UnitedHealthcare reimbursement policies may use Current Procedural Terminology (CPT *), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement.
Provider based billing refers to services rendered in a hospital-based outpatient clinic or location. UnitedHealthcare recognizes the Place of Service (POS) 11 (Office) CPT definition and will not reimburse the facility component of provider-based bil ling when the coinciding professional claim is reported for the same member on the same date ...
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