AAPC - Back to school
Results 1 to 3 of 3

Thread: fee schedules

  1. #1
    Join Date
    Apr 2007

    Default fee schedules

    AAPC: Back to School
    Can anyone answer a question regarding fee schedules. In NC can you have 2 fee schedules-one for cosmetic procedures and one for ins/private pay procedures.
    Last edited by Arlene; 02-10-2009 at 02:24 PM.

  2. #2
    Join Date
    Apr 2007
    Lincoln, NE


    This has always been a scary area for me. Most PPO contracts, as well as Medicare and Medicaid particiption agreements, contain language that provider will submit their "usual" charge. If you are running 2 fee schedules then how do you define your usual charge? You may have to defend your position. With the advances in medical and reconstructive procedures, more and more cosmetic procedures are becoming insurance covered procedures...examples: breast reconstruction following mastectomy or abdominoplasty following gastric bypass. So, if you are willing to accept $500 as payment in full from a patient that is paying cash but submit a claim to Medicaid for $1500 for the same procedure is this appropriate???? If you do elect to have 2 fee schedules I would make sure that your cosmetic fee schedule is NOT lower that ANY of your payers, including Medicare and Medicaid. I bill anesthesia and we have facilities that do cosmetic procedures. We bill using the same charge calculation methodology for all services (cosmetic or not) and what we will accept as payment in full is dependent on the plastics specific facility contract, if no facility contract exists then we expect payment based on our insurance (if covered procedure) contract or from the patient.

    Julie, CPC
    Last edited by jdrueppel; 02-15-2009 at 12:52 PM.

  3. #3
    Join Date
    Apr 2007


    Quote Originally Posted by Arlene View Post
    Can anyone answer a question regarding fee schedules. In NC can you have 2 fee schedules-one for cosmetic procedures and one for ins/private pay procedures.
    I don't know the law within your state, but I find it easier to maintain one fee schedule regardless. My surgeon does cosmetic surgery and reconstructive surgery, we charge the same regardless of who is paying.
    Susan Ward, CPC, COC, CPC-I, CEMC, CPCD, CPRC
    AAPC ICD-10 Expert Trainer

    A small act of kindness a day can make someone's day special

Similar Threads

  1. Fee schedules
    By msrainbird in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 11-12-2012, 03:11 PM
  2. 2 Fee Schedules
    By Christina Sachs in forum General Discussion
    Replies: 2
    Last Post: 02-15-2012, 07:48 AM
  3. Fee Schedules for NJ Help!!!
    By ivonneatanacio in forum Orthopaedics
    Replies: 0
    Last Post: 02-23-2011, 12:42 PM
  4. Different Fee Schedules
    By cynthiar in forum Medical Coding General Discussion
    Replies: 6
    Last Post: 02-03-2009, 03:07 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.