2009 Volume 1 Issue 3
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June 1, 2009
Issue No. 1
In This Issue
PH Updates Fees
PH General Surgery Fees
PH E&M Fees
PH New Fees

Newsletter Archive
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Scheduler Training
Is your office using the new signature scheduler?  IPC will be providing informational web conference training for new and experienced users.  This is also a great opportunity to demo the product. Contact Rachel if interested.
 
Greetings!
Priority Health's new fee schedule became effective 5/1. Please take time to read this newsletter to see how it will effect your practice.
PH Fee Changes
Priority Health adjusted its fees May 1, 2009 for West Michigan providers.  Most - but not all - visit codes (both office and facility) saw an increase.  Some of the most common specialty services rendered by IPC clients, however, had fees cut.  Hardest hit of those common codes was CPT 63047 Removal of Spinal Lamina with a decrease of 21% although even with the decrease, Priority Health's fee is significantly above Medicare's fees.  That is true of many of the other specialty fees as well.  Before this new adjustment, some surgical fees were 2-3 times higher than Medicare fees so it appears Priority Health is attempting to bring its fee schedule into line.
 
At this point, it's difficult to anticipate the real-world impact on client revenue but clearly there will be a few winners and a few losers.

Click here to see Priority Health's new E&M Fees or General Surgery Fees.
 
SPECPH Selected General Surgery Fees

Code

Description

Previous

5/1/2009

% Change

21555

REMOVE LESION, NECK/CHEST

$     41.97

 $   493.27

11.61%

49000

EXPLORATION OF ABDOMEN

$   939.24

 $   944.14

0.52%

49505

PRP I/HERN INIT REDUC >5 YR

$   617.88

 $   625.85

1.29%

44950

APPENDECTOMY

$   681.64

 $   701.71

2.94%

44970

LAPAROSCOPY, APPENDECTOMY

$   618.90

 $   644.51

4.14%


EMFEESPH E&M Fees

Code

Description

Previous

5/1/2009

% Change

99201

OFFICE/OUTPT VISIT, NEW

$    42.23

 $    42.70

1.11%

99202

OFFICE/OUTPT VISIT, NEW

$    74.87

 $    75.71

1.12%

99203

OFFICE/OUTPT VISIT, NEW

$  111.44

 $  112.68

1.11%

99204

OFFICE/OUTPT VISIT, NEW

$  157.58

 $  164.27

4.25%

99205

OFFICE/OUTPT VISIT, NEW

$  199.37

 $  208.74

4.70%

99211

OFFICE/OUTPT VISIT, EST

$    21.48

 $    25.34

17.97%

99212

OFFICE/OUTPT VISIT, EST

$    40.00

 $    45.35

13.38%

99213

OFFICE/OUTPT VISIT, EST

$    64.82

 $    65.28

0.71%

99214

OFFICE/OUTPT VISIT, EST

$    98.40

 $    98.92

0.53%

99215

OFFICE/OUTPT VISIT, EST

$  133.55

 $  142.40

6.63%

99217

OBSERVATION CARE DISCH.

$    74.14

 $    86.86

17.16%

99218

OBSERVATION CARE

$    70.17

 $    82.17

17.11%

99219

OBSERVATION CARE

$  116.16

 $  135.70

16.82%

99220

OBSERVATION CARE

$  163.34

 $  190.65

16.72%

99221

INITIAL HOSP CARE

$   96.34

 $    94.04

-2.39%

99222

INITIAL HOSP CARE

$  134.80

 $  139.32

3.35%

99223

INITIAL HOSP CARE

$  196.65

 $  194.00

-1.35%

99231

SUBSEQUENT HOSP CARE

$    40.44

 $    41.66

3.02%

99232

SUBSEQUENT HOSP CARE

$    72.16

 $    70.74

-1.97%

99233

SUBSEQUENT HOSP CARE

$  103.08

 $  100.59

-2.42%

99234

OBSERV/HOSP SAME DATE

$  141.14

 $  165.29

17.11%

99235

OBSERV/HOSP SAME DATE

$  185.94

 $  217.88

17.18%

99236

OBSERV/HOSP SAME DATE

$  231.93

 $  270.94

16.82%

99238

HOSP DISCHARGE DAY

$    73.74

 $    86.86

17.79%

99239

HOSP DISCHARGE DAY

$  106.65

 $  125.37

17.55%

99241

OFFICE CONSULTATION

$    57.94

 $    59.73

3.09%

99242

OFFICE CONSULTATION

$  105.87

 $  108.04

2.05%

99243

OFFICE CONSULTATION

$  141.17

 $  147.02

4.14%

99244

OFFICE CONSULTATION

$  198.67

 $  211.55

6.49%

99245

OFFICE CONSULTATION

$  257.05

 $  268.16

4.32%

99251

INPT CONSULTATION

$    41.39

 $    50.08

20.99%

99252

INPT CONSULTATION

$    83.22

 $    87.55

5.20%

99253

INPT CONSULTATION

$  113.72

 $  123.21

8.34%

99254

INPT CONSULTATION

$  163.38

 $  175.31

7.30%

99255

INPT CONSULTATION

$  225.25

 $  234.59

4.15%

99291

CRITICAL CARE, 1st HOUR

$  323.64

 $  334.80

3.45%

99292

CRITICAL CARE, ADD'L 1/2 HR

$  145.89

 $  150.72

3.31%


About Us
If you have any questions regarding this newsletter, you can contact us at:

         Mary Ellen Duffy
[email protected]
         Patricia Nevala [email protected]

or call us at 616-459-6867 or 800-606-1455

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