Copay for 99215 & 90868

[Blackhorse]

One of our local office charge copay $40 for 99215 & 99417, and charge $40 copay again for 90868 on the same day. Is this correct? Do you have to pay two copay for E/M plus the procedure? The insurance is Cigna.

 

[thomas7331]

You would have to ask Cigna. The insurance companies determine what services require a copay and how much they are. If the office is unable to determine this, it’s ok to estimate what the patient will owe, but if the insurance applies a different copay amount when the claim is processed, then they may need to refund the overpayment back to the patient.

 

[Blackhorse]

You would have to ask Cigna. The insurance companies determine what services require a copay and how much they are. If the office is unable to determine this, it’s ok to estimate what the patient will owe, but if the insurance applies a different copay amount when the claim is processed, then they may need to refund the overpayment back to the patient.

Thank you

 

[sls314]

You would have to ask Cigna. The insurance companies determine what services require a copay and how much they are. If the office is unable to determine this, it’s ok to estimate what the patient will owe, but if the insurance applies a different copay amount when the claim is processed, then they may need to refund the overpayment back to the patient.

Agree.

And keep in mind that it can also be driven by the benefit plan, so 2 CIGNA policies from different groups could process differently. (Same goes for any other insurer)

A patient could have a benefit plan that limits to one copay per day per provider. Another patient could have a benefit plan that applies a copay to each CPT code.