David Posted Sat 13th of June, 2015 07:22:10 AM
Can you bill 97755 in Florida? Does this code exist in Florida? If yes, what is the reimbursement for Workers Compensation, Car Accident Cases, Medicare, and Private Insurance?
SuperCoder Answered Mon 15th of June, 2015 02:54:57 AM
Yes, code 97755 is valid and reimbursable in Florida. Reimbursement varies from one payer to another, and it's updated every quarter to every year, depending again on the payer. So you need remain updated while billing for a code and DOS plays a very important factor here. Please check with the payer's latest fee schedule information if you already do not have one.
Private insurances have their individual fee schedules and payment rules therefore you need to contact them directly to get the latest information. Each private insurance have their own reimbursement rules. Same goes with car accident cases where payer decides the payment structure depending on various factors.
For Q2, 2015, Medicare payment rate (non-facility) for 97755 in Florida -->
For Fort Lauderdale: $37.02
For Miami, FL --> $37.02
For Rest of Florida --> $37.02
You will get WC payment rates for Florida here: http://www.myfloridacfo.com/division/wc/pdf/Hospital_Manual.pdf
If payment for 97755 is not available, you need to check with the payer for the same. You can also check the below document though it's a draft copy: