Billing for a School Physical

Billing for a School Physical

Schools may require a “sports physical” for students prior to participation in sports or other programs. Typically, a healthcare provider must perform a physical exam and fill out the required form. There are two common choices to document and bill for these exams.

  1. Charge a Flat Fee

Some offices choose to set a flat fee to fill out the school physical form and collect it from the patient, without billing insurance. The patient agrees to pay the lower fee for the reduced exam required, and agrees not to file insurance.

  1. Make the Physical Part of a Well Visit

The other common option is to incorporate the school physical into a well-child check. The form can be filed into the chart to document the exam, and the rest of the well-child check can be documented in the visit note; or, a full well-child check can be documented, with the form filled out, in addition. Because a full well-child check is performed, it can be billed to insurance.
Some offices have a strict policy and only offer one option, while others offer both and let the patient choose which works best for his or her situation. Either way, make sure the patient understands your policy and billing procedures.
Similar policies could be applied to other types of physicals, such as pre-employment physicals, commercial drivers license (CDL) physicals, etc. Note, however, that with the increasing regulations and certifications required (in some states) to perform a CDL physical, more providers are choosing to not offer a CDL physical as part of a wellness visit. The CDL physical requires an extensive exam, time, and decision-making, and does not allow enough time to address the preventive aspects of a wellness visit. Providers feel that performing a CDL physical as part of a wellness visit is a disservice to the patient because the provider is not able to adequately perform the comprehensive wellness visit, in addition to the CDL physical.
There is a CPT® code for filling out forms (99080), but it is not a covered benefit with most plans. Although you could report 99080 instead of billing the patient directly, the bill most likely will be the patient’s responsibility, after the insurance processes.

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Karla Hurraw, CPC, CCS-P, holds a degree in Medical Office Administration and is the Lead Professional Coder for DeKalb Health Medical Group at DeKalb Health in Auburn, Ind. She is a member of the Fort Wayne, Ind., local chapter.

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