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Pediatric Coding Alert

Pediatric Payment:

99460: Look for a 61 Percent Boost to Your Initial Newborn Care Services

Plus: Office-based well child visits also get a raise. You may not treat Medicare patients, but most pediatricians know that private carriers frequently base payment rates on the Medicare Physician Fee Schedule--and this year, you'll be seeing significant pay raises to many of the most commonly-billed pediatric codes. Background: The Centers for Medicare & Medicaid Services (CMS) updates its fee schedule on a quarterly basis. The fee schedule assigns different relative value units (RVUs) to every available CPT code. Most insurers subsequently use those values to set rates for physician services, even for non-Medicare patients--which is why these values are important to pediatricians. Most code values do not change dramatically from one year to the next. For instance, code 99213 (Office or other outpatient visit...) was assigned 0.97 RVUs in both 2011 and 2012. When multiplied by Medicare's conversion factor of $34.0376, that code pays about $33.00. Other [...]