Non-payment of facility charge for PBC

Quick question, as more insurances are not reimbursing for the facility charge separately on the UB-04, when the service is provided in a provider-based clinic, what are other organization's doing to compensate for that reduction in revenue for these services. Our latest notification, from Summacare, states that effective 6/1/24, they too will not separately reimburse for a clinic or facility fee associated with space to provide and E & M service on a UB-04. Just wondering how other organizations are addressing this. Thank you in advance for your feedback.


  • edited May 10

    If the physicians are employed, you can bill their pro fee with POS 11 and get the higher payment.

    and of course address this in contracting.

  • We attempt to get revenue neutrality clauses in contracts, so that when policy changes impact the expected value of a contract, we can pursue an increase in the still billable portion of the visit.

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