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October 2013

Change in reporting codes for professional urgent care services

Health care providers should report the add-on procedure code S9088 in location 22 (outpatient), with a $0 charge, for members who have the professional urgent care services benefit. This change is effective on or after April 1, 2013, and it applies to both electronic and paper CMS-1500 claim formats.

Procedure code S9088 is not separately payable and should be reported in addition to the appropriate office visit code: *99201-*99205 or *99211-*99215.

Don’t report this add-on urgent care service code for professional services performed in the outpatient location that aren’t for urgent care. In addition, only professional charges should be submitted.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
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