June 1, 2009 |
Issue No. 1 | |
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Newsletter Archive
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Want to read a back issue of IPC's newsletter?
Click here!
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Scheduler Training
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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.
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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.
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| 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.
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 PH Selected General Surgery Fees
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Code
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Description
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Previous
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5/1/2009
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% Change
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21555
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REMOVE LESION,
NECK/CHEST
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$ 41.97
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$
493.27
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11.61%
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49000
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EXPLORATION OF ABDOMEN
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$ 939.24
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$
944.14
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0.52%
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49505
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PRP I/HERN INIT REDUC
>5 YR
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$ 617.88
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$
625.85
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1.29%
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44950
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APPENDECTOMY
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$ 681.64
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$
701.71
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2.94%
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44970
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LAPAROSCOPY,
APPENDECTOMY
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$ 618.90
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$
644.51
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4.14%
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PH E&M Fees
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Code
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Description
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Previous
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5/1/2009
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%
Change
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99201
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OFFICE/OUTPT
VISIT, NEW
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$ 42.23
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$
42.70
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1.11%
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99202
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OFFICE/OUTPT
VISIT, NEW
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$
74.87
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$
75.71
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1.12%
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99203
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OFFICE/OUTPT
VISIT, NEW
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$
111.44
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$
112.68
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1.11%
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99204
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OFFICE/OUTPT
VISIT, NEW
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$ 157.58
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$
164.27
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4.25%
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99205
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OFFICE/OUTPT
VISIT, NEW
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$ 199.37
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$
208.74
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4.70%
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99211
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OFFICE/OUTPT
VISIT, EST
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$ 21.48
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$
25.34
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17.97%
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99212
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OFFICE/OUTPT
VISIT, EST
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$ 40.00
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$
45.35
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13.38%
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99213
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OFFICE/OUTPT
VISIT, EST
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$
64.82
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$
65.28
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0.71%
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99214
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OFFICE/OUTPT
VISIT, EST
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$ 98.40
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$
98.92
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0.53%
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99215
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OFFICE/OUTPT
VISIT, EST
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$ 133.55
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$
142.40
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6.63%
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99217
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OBSERVATION
CARE DISCH.
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$ 74.14
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$
86.86
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17.16%
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99218
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OBSERVATION
CARE
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$ 70.17
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$
82.17
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17.11%
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99219
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OBSERVATION
CARE
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$ 116.16
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$
135.70
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16.82%
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99220
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OBSERVATION
CARE
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$ 163.34
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$
190.65
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16.72%
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99221
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INITIAL
HOSP CARE
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$ 96.34
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$
94.04
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-2.39%
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99222
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INITIAL
HOSP CARE
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$ 134.80
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$
139.32
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3.35%
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99223
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INITIAL
HOSP CARE
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$ 196.65
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$
194.00
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-1.35%
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99231
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SUBSEQUENT
HOSP CARE
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$ 40.44
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$
41.66
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3.02%
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99232
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SUBSEQUENT
HOSP CARE
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$ 72.16
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$
70.74
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-1.97%
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99233
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SUBSEQUENT
HOSP CARE
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$ 103.08
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$ 100.59
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-2.42%
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99234
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OBSERV/HOSP
SAME DATE
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$ 141.14
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$
165.29
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17.11%
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99235
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OBSERV/HOSP
SAME DATE
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$ 185.94
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$
217.88
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17.18%
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99236
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OBSERV/HOSP
SAME DATE
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$ 231.93
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$
270.94
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16.82%
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99238
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HOSP
DISCHARGE DAY
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$ 73.74
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$
86.86
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17.79%
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99239
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HOSP
DISCHARGE DAY
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$ 106.65
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$
125.37
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17.55%
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99241
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OFFICE
CONSULTATION
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$ 57.94
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$
59.73
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3.09%
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99242
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OFFICE
CONSULTATION
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$
105.87
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$ 108.04
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2.05%
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99243
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OFFICE
CONSULTATION
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$ 141.17
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$
147.02
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4.14%
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99244
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OFFICE
CONSULTATION
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$ 198.67
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$
211.55
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6.49%
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99245
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OFFICE
CONSULTATION
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$ 257.05
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$
268.16
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4.32%
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99251
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INPT
CONSULTATION
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$ 41.39
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$
50.08
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20.99%
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99252
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INPT
CONSULTATION
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$ 83.22
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$
87.55
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5.20%
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99253
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INPT
CONSULTATION
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$ 113.72
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$
123.21
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8.34%
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99254
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INPT
CONSULTATION
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$ 163.38
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$
175.31
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7.30%
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99255
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INPT
CONSULTATION
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$ 225.25
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$
234.59
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4.15%
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99291
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CRITICAL
CARE, 1st HOUR
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$ 323.64
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$
334.80
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3.45%
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99292
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CRITICAL
CARE, ADD'L 1/2 HR
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$ 145.89
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$
150.72
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3.31%
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| About Us |
If you have any questions regarding this newsletter, you can contact us at:
Mary Ellen Duffy med@ipcbilling.com Patricia Nevala pat@ipcbilling.comor call us at 616-459-6867 or 800-606-1455
Please feel free to forward this newsletter to your staff and peers.
Innovative Practice Concepts, LLC -- A full service medical billing company
Your Bottom Line is our Top Priority!
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