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Non-Medicare Fee Schedules

suemt

Expert
Messages
304
Best answers
0
Does anyone know where to find fee schedules for commercial insurance plans in New York? I know how to find the anticipated fees for Medicare, but not the other insurance companies.

In particular, I'm looking for imaging studies (echo, carotid, sonograms, etc.)

Thanks in advance!

Sue
 

beckiw

Networker
Messages
91
Best answers
0
That's a tricky question. Every insurance company has their own reimbursement schedule. Some publish is freely - like Medicare. In my state, Blue Cross is published as well, so is workers compensation. But for most commercial carriers, this information is not freely published. You can try the various websites for those carriers. If you participate and have a log-in for their websites, it's possible the information is there.

If you participate, you can probably call and ask for a fee schedule for your specialty. If you don't participate, they aren't likely to give it to you.

Good luck.
 

suemt

Expert
Messages
304
Best answers
0
OK, let's try another tactic. How about if I list some procedure codes and if anyone in downstate NY has gotten these paid in this calendar year (2012) by any of these insurance plans, you tell me the allowed amount.

Here's what I have so far:

Proc Code Empire BC PPO (2012 DOS)

51798
76536-TC
76700-TC 71.88
76705-TC
76770-TC
93306-TC 212.32
93880-TC 141.21
93922 118.85
93925-TC
93926-TC
93930-TC
93931-TC
93970-TC
93971-TC
93975-TC
93978-TC

Proc Code United Health Care (2011 DOS)

51798
76536-TC
76700-TC
76705-TC
76770-TC
93306-TC 209.43
93880-TC 193.75
93922 102.68
93925-TC
93926-TC
93930-TC
93931-TC
93970-TC
93971-TC
93975-TC
93978-TC

Proc Code UHC Empire Plan (2012 DOS)

51798
76536-TC
76700-TC
76705-TC 49.95
76770-TC 122.90
93306-TC 350.00
93880-TC 189.90
93922 77.00
93925-TC
93926-TC
93930-TC
93931-TC
93970-TC
93971-TC
93975-TC
93978-TC

Proc Code Oxford (2012 DOS)

51798
76536-TC
76700-TC
76705-TC
76770-TC
93306-TC 209.43
93880-TC (specialist only is reimbursed)
93922 100.71
93925-TC
93926-TC
93930-TC
93931-TC
93970-TC
93971-TC
93975-TC
93978-TC
 

suemt

Expert
Messages
304
Best answers
0
I was able to develop quite a bit of this information, so if anyone needs it, just let me know.
 

inc1961

Networker
Messages
54
Location
Oriskany Falls, NY
Best answers
0
I am doing research on CPT 93922, and CPT 95943 for a new client.
Are there any criteria for billing these two codes? I have check local coverage determinations for NGS and Novitas (our Medicare MACs) but have come up empty handed.

Are there specific diagnosis codes that process favorably.

Is there a specific POS that processes favorably?

Thanks in advance.
 
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