Starting Sept. 1, Aetna will pay 75% of the contracted rate for surgical procedures performed in urgent care facilities or independent clinics with or without modifier 54, used to indicate surgical care, according to a recent health plan update. Aetna says the change is part of its plans to expand its modifier 54 policy to include place-of-service codes 20 and 49, used when services are provided at an urgent care facility or at an independent clinic. The payer also will institute similar payment cuts for surgical procedures when billed by nurse practitioners or physician assistants.
Wound Care practitioners who bill site of service 49 (independent clinic) take note! And be aware that payments for surgical procedures like debridements will be reduced if they are performed by an NP or PA.
