Reimbuursement issue

codedog

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956
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NEW ORLEANS
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How do I know what price to to bill on a CPT code when we dont have a price on a cpt code that is new or we never done beforein the system. Is there a formula you go by , or what?. AN example would be say 65779 ,itsv a new code this year. Please help,it seems we have this issue all the time , Thanks trent
 

MMAYCOCK

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How do I know what price to to bill on a CPT code when we dont have a price on a cpt code that is new or we never done beforein the system. Is there a formula you go by , or what?. AN example would be say 65779 ,itsv a new code this year. Please help,it seems we have this issue all the time , Thanks trent
If your practice has not done its own analysis to develop costing data, you can use the CMS fee schedule in your area and establish a consistent conversion factor to establish your own. After a quarter you can compare the charges to the cost of those procedures and adjust as appropriate.
We are in a WPS locality. Here is their current fee schedule. You can go to your contractor website and get the fee schedule for your area. Because Michigan is not a higher cost location, it may be quite different depending on your locality. http://www.wpsmedicare.com/part_b/fees/physician_fee_schedule/_files/2011-mi-01.pdf
 
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