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How much should I charge for CPT codes based off of Medicare allowables?

Marina Posted Tue 05th of February, 2013 21:10:41 PM

When entering office visit/procedure codes, how much should I charge based off of what Medicare allows. For example: for CPT code 99213, Medicare allows $75.70. Should I double this amount when charging patients and insurance companies? I don't want to over charge our patients or other insurance companies.

SuperCoder Answered Tue 12th of February, 2013 20:14:51 PM

In choosing the percentage, you should consider the area you practice in and review your own payer contracts. Experts suggest 200 to 300 percent of Medicare can be OK, although there’s some variation. E.g., maybe family practices will be closer to150 to 200 percent while specialists choose something higher.

To understand work with Medicare patients, review this AMA document:

http://www.ama-assn.org/ama1/pub/upload/mm/399/medicare-par/know-options-medicare-participation-guide.pdf.

There’s also a fee schedule toolkit at http://www.ama-assn.org/ama/pub/physician-resources/practice-management-center/knowledge-center/practice-management-toolkits/defensible-fee-schedule-toolkit.page

And there are additional tips in this article: http://www.ama-assn.org/amednews/2009/05/04/bisa0504.htm

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