fee schedule

  1. dcrossman

    Wiki Determining how much to set your fee schedule

    I'm having a hard time determining how much to set prices at for our office. I use the RVU/ Medicare Allowable rate to see what Medicare's allowed amount is, but I know that I need to set our prices significantly higher than that for other payors like Anthem, Cigna, etc. Historically, I've...
  2. M

    Wiki CPT codes 20553 vs. 20552 cost error?

    Hi everyone! I just started coding a few months ago and I have a question pertaining to CPT codes. I’m coding trigger point injections for a pain management practice, and the 20552 code comes up as $650, while the 20553 code comes up as $250. Doesn’t this seem backwards? Why would less work...
  3. K

    Wiki Fee Schedule Question

    Hello, If a payer reimburses for a code at your full charge, and when you reach out to the payer you realize your allowable is higher than your charge, is it okay to send a corrected claim with higher charge on the code to maximize reimbursement for that service? If yes, can you send the...
  4. I

    Wiki OBL

    Does anyone know where i can find all the procedures that can be done in an OBL (Office Based Labs), Medicare reimbursement for them as well? Any insight would be greatly appreciated.
  5. C

    Wiki Self-Pay Fee Schedule

    What formula are other practices using to create a Self-Pay Fee Schedule? Some of my research shows Medicare x 120%. Does anyone have any useful links? Thanks, Wendy
  6. A

    Wiki National Average Reimbursement

    Lately we found out Horizon BCBS NJX use National Average Reimbursement as fee schedule to process our claim. Dose any one know detail about this fee schedule?
  7. M

    Wiki ASC fee schedules updates

    I've pulled the Addendum for Final ASC Covered Surgical Procedures for CY2019. 14301 is not listed. Does that mean they've deleted and don't consider that a procedure that is covered in ASC setting? It was on the 2018 list. 11402 isn't on the Jan addendum either.
  8. M

    Wiki fee schedule for procedures in ASC

    I've pulled the Addendum for Final ASC Covered Surgical Procedures for CY2019. 14301 is not listed. Does that mean they've deleted and don't consider that a procedure that is covered in ASC setting? It was on the 2018 list. 11402 isn't on the Jan addendum either.
  9. E

    Wiki Remote Physicians Office Alaska - New Practice Credentialing/Reimbursement Schedule

    I am currently working for a group practice that serves both the Anchorage, AK area and the Kodiak, AK area. Kodiak being a remote service location with minimal clinic and hospital coverage for maternity care. The practice is new and wants to be able to charge a higher remote service location...
  10. H

    Wiki Where do I find the 2018 ASC medicare fee schedule

    I work in a specialist office and work in conjunction with an ASC. I have been having a very difficult time finding the 2018 Medicare ASC fee schedule. Where do I find it? Any assistance would be appreciated. Sorry for novice question; I'm still new to this.
  11. C

    Wiki Changing fee schedule billing different cost same day???

    Hello, I am trying to confirm information regarding a recent fee schedule change we've had in our office. We have two coders in our office who are coding and billing claims on different dates of service between 10/1/15 to current 3/2/16. On 2/15/16 we updated our fee schedule to reflect...
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