Horizon Site of Service Payment Policy Change Lowers Physician Payments in ASCs effective December 1

    By: Amanda Shiber on Nov 08, 2016

    On September 1, Horizon posted notice on its website regarding changes, effective December 1, to its reimbursement policy involving site of service differential for surgical CPT codes (10000 through 69999). Effective December 1, "any setting designated as a facility by CMS will be reimbursed [by Horizon] using the facility relative value units (RVUs)." The most notable change is that Ambulatory Surgery Centers will now be designated as facilities by Horizon. While not all surgical CPT codes have lower RVUs when performed in a facility versus non-facility, it appears that payment for some procedure codes will be significantly reduced.

    MSNJ has asked Horizon to delay the effective date due to our concerns over adequate notice. We are continuing to investigate the impact of this policy change on members since any adverse change to physician agreements requires at least 90 days notice. Please tell us how this will impact your practice and how you received notice of this policy change.


    Released: November 8, 2016, 10:09 am
    Keywords: Announcements

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