Urgent care

Applies to:

All plans

Definition

Care provided at an urgent care center, instead of a hospital emergency room, when the patient needs immediate care to treat a non-life threatening illness or injury to limit severity and prevent complications. 

Urgent care authorizations

HMO plan members should contact their PCP's office before going to an urgent care center, but Priority Health does not require authorization for urgent care services.

Urgent care billing

Member benefits differ if the urgent care is received from a non-participating provider.

Bill services obtained in an urgent care setting as follows.

Hospital-based urgent care

UB-04: Rev Code 456 or 516 (whichever is appropriate) with corresponding E&M code*

1500: POS 22 with corresponding E&M code

Independent urgent care

CMS-1500: POS 20 with corresponding E&M code*

*Member liability will be applied if applicable