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Thread: Discounts for self pay patients

  1. #1

    Question Discounts for self pay patients

    AAPC: Back to School
    I'm not exactly sure how to word this...
    Can a physician give discounts to uninsured patients "legally" as long as the fee schedule for self pay and insurred patients is the same?

    An insured pt gets a holter monitor for a fee of 410.00, but the fee schedule
    with the insurance is, say 210.00. The insurance says to adjust off 200.00, then pays the 210.00 and the patient has a $0 balance.
    Can a physician do this same adjustment for a self pay patient. Billing the 410.00, but releasing only the 210.00 to the pt and giving a 200.00 "discount"?

    It's a discussion we are having in our office, and there are varrying opinions. If there is a website that spells this out, that would be extremely helpful.

    Thank You

  2. #2
    Join Date
    Apr 2007
    Kingsport, TN

    Default Discounts for uninsured

    Here is a link from CMS that might be helpful:


  3. #3


    It's my understanding that as long as your practice has a policy set in place to treat all selfpay patients the same, it is absolutely ok. Some practices always discount 10% when patient pays on same day. Or you could do a set dollar amount adjustment...as long as each selfpay patient is treated equally. If a patient is insured by an insurance that your Provider is contracted with....that's when things get strict.


  4. #4


    Very Helpful, Thank You.

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