As previously communicated, reimbursement rates for emergency room/department (ER) services are inclusive of services provided to an Independence member during the visit. This reimbursement includes the professional components of laboratory and radiology for all managed care Benefit Programs. Therefore, there is no separate or additional reimbursement for these services.

ER services when billed with surgical services

If an ER visit includes surgery performed in a fully equipped and staffed operating room, the facility will receive fee schedule reimbursement for the ER visit and the surgery. In this circumstance, the surgery should be billed using an appropriate surgery revenue code with the applicable HCPCS/CPT^® code.

When surgical services are performed in the ER and not a fully equipped operating room, the surgical services are included in the reimbursement for the ER visit. In this circumstance, the surgery should be billed using an appropriate ER revenue code with the applicable HCPCS/CPT code.

Learn more

Additional information regarding observation services in the ER can be found in the Billing & Reimbursement for Hospital Services section of the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers.

For more information regarding reimbursement for emergency room services, please review the following policies:

• Commercial: #00.10.03i: Criteria for Reimbursement of Emergency Room Services
• Medicare Advantage: #MA00.044a: Criteria for Reimbursement of Emergency Room Services

If you have any questions, please contact your Network Coordinator.

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