Facility Reimbursement for Clinic Services
Defines when hospitals may receive separate reimbursement for outpatient clinic services (revenue codes 510-519) for Florida Blue commercial products; applies to all lines of business and providers but excludes Medicare products.
No material clinical or coverage changes in this revision.
When a Separate Facility Clinic Fee Is Reimbursed
Separate facility clinic fee reimbursement criteria
Covered when ALL of the following are met:
ALL of the following
- Service falls within scope: hospital clinic services (preventive, diagnostic, therapeutic, rehabilitative, palliative, or educational non-emergency outpatient services furnished to ambulatory patients).
- Applies to Florida Blue commercial products only (does not apply to Medicare products).
- Hospital is not already receiving payment from the physician for use of the hospital's clinic via any other form of agreement (for example, rental or lease arrangement).
Hospitals should confirm no payment arrangement exists with the physician.
- Clinic revenue code reported is within the 510-519 range (Clinic Services).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.