Provider-Based Billing at MUSC Health
What is Provider-Based Billing (PBB)?
Provider-based billing, or hospital-based outpatient billing, is a type of billing for services provided in a clinic or department that is a part of a hospital. These clinics or departments located miles away from the main hospital campus can be considered part of the hospital.
Why are we using PBB?
This model is commonly used by health systems across South Carolina and the nation and aligns with Centers for Medicare and Medicaid Services (CMS) payment programs. It also supports MUSC Health’s ability to deliver safe, high-quality care. By operating as a hospital outpatient department, this location meets additional regulatory requirements and is held to higher standards of care. It is also subject to oversight by an accreditation organization. Furthermore, it allows us to deliver coordinated, hospital-level outpatient care while maintaining the high safety and quality standards patients expect from MUSC Health.
How does PBB affect your bill?
Visits to provider-based clinics will result in two charges:
- A professional or physician charge for outpatient services and/or procedures, and
- A facility charge from the hospital for resources and services such as procedures.
For patients with insurance, physician services will be processed under physician benefits, which are generally subject to patient copays. Hospital services are processed under hospital benefits and subject to deductibles and coinsurance.
How does PBB affect copays and deductibles?
Copays and deductibles at provider-based clinics will depend on specific insurance benefits. Medicare patients will incur a coinsurance cost to the hospital. Coinsurance and deductibles are generally covered by secondary insurance with Medicare.
Patients who do not have secondary or supplemental insurance may have additional out-of-pocket expenses to meet their annual deductible and co-pay. Patients should check with their insurance provider to understand their specific financial responsibility with provider-based billing. There may be cases where out of pocket expenses are more at provider-based locations than other facilities.
Who should you contact with questions?
We are happy to discuss payment options and answer any questions you may have. We understand that this information may raise questions, and we are here to help. Please do not hesitate to contact us at 843-792-2311 or 800-598-0624 with any questions or concerns.
What locations use provider-based billing?
PBB affects services offered at the following locations:
- MUSC Medical Center
- Ashley River Tower, 25 Courtenay Drive
- Rutledge Tower, 135 Rutledge Avenue
- Shawn Jenkins Children’s Hospital, 10 McClennan Banks Drive
- MUSC Health Institute of Psychiatry, 67 President Street
- MUSC Health Pharmacotherapy at East Cooper Medical Pavilion, 1600 Midtown Ave
- MUSC Health Pulmonary Function Testing Lab at East Cooper Medical Pavilion, 1600 Midtown Ave
- MUSC Health Speech Therapy at East Cooper Medical Pavilion, 1600 Midtown Ave
- MUSC Health Radiation Medicine - Mount Pleasant, 1180 Hospital Drive
- MUSC Health Primary Care - Ellis Oak, 650 Ellis Oak Avenue
- MUSC Health Physical and Occupational Therapy - Mt Pleasant, 1280 Hospital Drive
- MUSC Children’s Health After Hours & Specality Care - Summerville, 4330 Ladson Road
- MUSC Children’s Health R. Keith Summey Medical Pavilion, 2250 Mall Drive
- MUSC Children’s Health Day Treatment - Star Program, 1001B Michigan Avenue
- MUSC Health Oncology & Infusion Services, 2575 Elms Center Road
- MUSC Health PT/OT, 2575 Elms Center Road
- MUSC Health North Charleston - Elms Center Oncology & Infusion Services, PT/OT, 2575 Elms Center Road
- MUSC Health West Ashley Medical Pavilion Operating Rooms & PT/OT, 2060 Sam Rittenberg Blvd
- MUSC Children’s Health Specialty & After Hours Care - Mt Pleasant, 2705 N Highway 17
- MUSC Health Pediatrics & Internal Medicine - Dantzler, 2750 Dantzler Drive
- MUSC Children’s Health Physical Therapy - Leeds, 4480 Leeds Place West
- MUSC Children’s Health Occupational Therapy - Leeds, 4481 Leeds Place West
- MUSC Children’s Health Speech-Language Pathology - Leeds, 4482 Leeds Place West
- MUSC Health Nexton Medical Park, Infusion & Oncology, MUSC Health Nexton Medical Park
- MUSC Health Pulmonary Rehabilitation - Bee Street, 122 Bee Street
- MUSC Health Neurologic Rehabilitation Institute, 1014 St. Andrews Blvd
- MUSC Health Primary Care - Springview, 87 Springview Lane
- MUSC Women’s Health, 135 Cannon Street
- MUSC Health Revisions Adult Intensive Outpatient Therapy & Eating Disorder, 1176 Sam Rittenburg Blvd
- MUSC Health – Wound Care and Hyperbaric Medicine – Charleston, 96 Jonathan Lucas Street
- MUSC Hollings Cancer Center, 86 Jonathan Lucas St
- MUSC Hollings Cancer Center Infusion Services, 122 Okatie Center Blvd
- MUSC Hollings Cancer Center Breast Care, 122 Okatie Center Blvd
- MUSC Health Therapeutic Services, 158 Ashley Avenue
- Clements Ferry Pavillion PT/OT, 1101 Waterline Street
- Chuck Dawley MRI, 1106 Chuck Dawley Blvd
- MUSC Health Infusion Services, 1315 Roberts Street
- MUSC Health – Kiawah Partners Pavilion FSED, Lab, PT/OT, 1857 Seabrook Island Road
- MUSC Health Dialysis Access Institute, 3000 St Matthews Road
- MUSC Health Endocrinology - Orangeburg, 1175 Cook Road
- MUSC Health Urology - Orangeburg, 1175 Cook Road
- MUSC Health General Surgery - Orangeburg, 1175 Cook Road
- MUSC Health Orthopaedic Urgent Care - Orangeburg, 3000 St Matthews Road
- MUSC Health Heart and Vascular, 1175 Cook Road
- MUSC Health Cardiology - Orangeburg, 1175 Cook Road
- MUSC Hollings Cancer Center Orangeburg, 1161 Cook Road
- MUSC Health Bamberg-Barnwell Medical Pavilion, 1524 Barnwell Hwy
- MUSC HealthPlex - Santee, 111 John Lawson Avenue
- MUSC HealthPlex | Fitness Center Orangeburg, 3000 St Matthews Road
- MUSC Health Florence Medical Center
- MUSC Health Jean and Hugh K. Leatherman Behavioral Care Pavilion, 121 East Cedar Street
- MUSC Health Adult Outpatient Behavioral Care Services, 121 East Cedar Street
- MUSC Health Youth Outpatient Behavioral Care Services, 121 East Cedar Street
- MUSC Health Physical Medicine and Rehabilitation, 805 Pamplico Hwy.
- MUSC Health Urology, 805 Pamplico Hwy.
- MUSC Health Cardiology, 805 Pamplico Hwy.
- MUSC Health Infectious Diseases, 805 Pamplico Hwy.
- Florence Health Rehabiliation Center - OP Therapies, 1925 Hoffmeyer Road
- MUSC Health - Rehab Services – Kingstree, 402 Nelson Blvd
- MUSC Rehab Services, 244 N. Ron McNair Blvd
- MUSC Health Lancaster Medical Center
- MUSC Health Physical Therapy - Indian Land, 1245 Rosemont Dr., Suite 101
- MUSC Health Physical Therapy - Lancaster, 1025 W Meeting St, Suite 103
- MUSC Health Lancaster Wound Care Center, 838 W Meeting St. Suite D
- MUSC Health Transplant Program - Mid-Carolinas, 820 W Meeting St.
- MUSC Health Hematology and Oncology, 834 W Meeting St., Suite H
- MUSC Health Chester Medical Center
- MUSC Health Primary Care Mullins, 511 S. Main Street
- MUSC Health Primary Care - Marion, 1205 N. Main Street
- MUSC Children’s Health Pediatrics - Marion Medical Center, 2845 E. Highway 76
- MUSC Health Primary Care - Lake City, 148 Sauls Street
- MUSC Health Express Care - Lake City, 148 Sauls Street
- MUSC Health Primary Care - Richburg, 3909 Lancaster Hwy
- MUSC Health Lowrys Primary Care, 517 Doctors Court
- MUSC Children’s Health Pediatrics - Chester, One Medical Park Drive
- MUSC Health Primary & Specialty Care at Lancaster Medical Center, 834 West Meeting Street
- MUSC Health Primary Care - Ron McNair Blvd., 276 N. Ron McNair Blvd
- MUSC Health Primary Care - Great Falls, 308 Chester Ave
- MUSC Health Primary Care - Thurgood Marshall, 500 Thurgood Marshall Blvd
- MUSC Health Kershaw Medical Center
- MUSC Health Senior Retreat, 1315 Roberts Street
- MUSC Health Elgin Medical Pavilion, 40 Pinacle Parkway
- MUSC Health Rehabilitation Services Lugoff Medical Pavilion, 1165 Highway 1 S
- MUSC Health Columbia Medical Center
- Proposed Name: MUSC Health Preoperative Assessment Clinic, 2701 Laurel Street
- MUSC Health Heart & Vascular Columbia Medical Park DT III, 1655 Bernardin Ave
- MUSC Health Imaging Center Columbia Medical Park DT I, 2750 Laurel St
- MUSC Health Vein Clinic at Laurel St. Pavilion, 2001 Laurel Street
- Pre-Admissions Testing, 2749 Laurel Street
- MUSC Health Wound Care Center Medical Park NE, 114 Gateway Corp Blvd
- MUSC Health Rehabilitation Services Columbia Medical Park NE, 114 Gateway Corporate Blvd
- MUSC Health Fairfield Emergency & Imaging, 1810 US Highway 321 S
- MUSC Health Cardiac Rehab/Pulmonary, 114 Gateway Corp. Blvd
