Wiki New E/M codes reimbursement

[tscobee]

Does anyone know how I could find the reimbursement for the new code series 98000-98015? BC/BS just says % of charge and with UHC, it depends on the patient. I've requested our fee schedule from Cigna, but it could take up to 10 days, and of course Medicare doesn't have it because they don't recognize these codes. I'm trying to add them to our system and I have no idea what to charge.

 

[tscobee]

Never mind! I found an insurance that gave me some allowables, so I'll just go off of that.

 

[csperoni]

Does anyone know how I could find the reimbursement for the new code series 98000-98015? BC/BS just says % of charge and with UHC, it depends on the patient. I've requested our fee schedule from Cigna, but it could take up to 10 days, and of course Medicare doesn't have it because they don't recognize these codes. I'm trying to add them to our system and I have no idea what to charge.

I know you already came up with an answer, but did want to make you aware that discussion to determine charges is something that is actually prohibited. And allowables (except for Medicare/Medicaid) are determined by your insurance contracts. So my allowable for 98000 by a particular payor is not necessarily your allowable for the same carrier.

 

[tscobee]

Thank you! I did know people had different contract negotiations, but it seemed like I wasn't getting anywhere with our insurances. I did finally find one. But thank you for letting me know. I didn't realize it was prohibited.