Wiki Insurance Reimbursement per CPT code

[stephen.schofield12@gmail.com]

I am a new CPC-A and am working for a new start up primary care clinic and I am trying to estimate how much revenue can be expected. Is there a resource somewhere that tells how much various insurance companies reimburse for primary care codes like 99201 etc? Thanks for the help.

 

[sls314]

Is your facility contracted with insurance companies? You should be able to contact your provider rep for a copy of your contracted fee schedule. (Or if you're contracted with insurers through a PHO or IPA, you would ask them for the contracted rates.)

Medicare and Medicaid fee schedules are public information that you can pull from CMS and your state's Medicaid website. This is the Medicare physician fee schedule lookup tool: https://www.cms.gov/apps/physician-fee-schedule/overview.aspx I'm not sure what state your clinic is located in, but I can help find it on your state's Medicaid website if you need it.

However, insurance company rates are specific to the contract. Even if another provider in your area shared their rates with you, it's possible that your rates could be slightly different. I would definitely refer to your insurance contracts if you need to know exactly what you should expect to be reimbursed for different codes.

 

[stephen.schofield12@gmail.com]

Thank you Susan. I was able to pull up the medicare for what I needed and I am sure I can find Alabama medicaid. My boss is supposed to be getting the contact person for our EHR software who handled all the insurance stuff. I'm hoping he'll have the fee schedules for the insurances we are accepting. Thanks again.