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Personal Injury

Alicia Posted Mon 28th of March, 2011 16:37:32 PM

Our Physician has asked us to charge PI patients a $25.00 copay can we do this since the copay is set determined by the insurance company?

SuperCoder Answered Tue 29th of March, 2011 16:33:15 PM

This is the amount you pay for each visit, regardless of whether the visit is covered by insurance. Yes, you are right that copay is set determined by the insurance; but usually it is either in ration like 80%/20% or 60%/40% . It might be that for each of these visit the level of visit is minimum level of 99203/99214 ($102 approx)that the doctor normally bills. Please check if this is the really the case or not. If yes, the doctor calculates the minimum one that is 20% of $102 comes out to be $25 approx.

So, this can be the reason why the doctor charges $25 per PI patient visit. But, you have to check on the fee value of CPTs the doctor normally bills. If it is lower than $100, then I find this questionable.

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