Fee Schedule Resources

ckkohler

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What are some good resources to use when setting a fee for a new procedure? Is there a book or manual that can be ordered?
Thanks for any guidance!
 

ckkohler

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the code in question happens to be a category III code, 0282T, for insertion of a peripheral nerve stimulator ... I can go out and find the Medicare fee, but, then how do I set our fee? How much of a percentage is added over and above the Medicare fee schedule? Thanks for the guidance.
 

mmorningstarcpc

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For 0232T Medicare has no allowable at this point. Being a Category III code means it is basically being tested to see if there truly is a need for such a code. Medicare at this time considers this to be experimental, and as such, it has no allowed amount. With that being said, it is a correct code and should be used in the appropriate situation. Using another code, such as unlisted, or a graft code, in order to be paid is incorrect coding. Refer to the Category III guidelines for complete understanding. Just FYI!
 

mhstrauss

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the code in question happens to be a category III code, 0282T, for insertion of a peripheral nerve stimulator ... I can go out and find the Medicare fee, but, then how do I set our fee? How much of a percentage is added over and above the Medicare fee schedule? Thanks for the guidance.
That is really up to your practice to set the fee. IMO, talk to one of the docs that perform this procedure, ask him how it compares to the work of a similar code. If, for example, he says its maybe about 25% more work than the similar code, add 25% to that fee. Does that make sense?

I did check our database for guidance, and there's no fee listed for it yet...sorry.

Hope this helps! :confused:
 
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