2009 Volume 1 Issue 3
logo June 1, 2009 Issue No. 1
In This Issue
PH Updates Fees
PH Gerontology Fees
PH E&M Fees
Newsletter Archive
Want to read a back issue of IPC's newsletter?
 Click here! 
PH New Fees

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  GERONTOLOGY Fees.
 
SPECPH Selected Gerontology Fees

Code

Description

Previous

5/1/2009

% Change

99304

NURSING FACILITY CARE, INIT

$76.22

$102.83

34.91%

99305

NURSING FACILITY CARE, INIT

$101.33

$143.22

41.34%

99306

NURSING FACILITY CARE, INIT

$124.68

$184.06

47.63%

99307

NURSING FAC CARE, SUBSEQ

$39.65

$50.72

27.92%

99308

NURSING FAC CARE, SUBSEQ

$65.64

$77.95

18.76%

99309

NURSING FAC CARE, SUBSEQ

$92.07

$104.24

13.22%

99310

NURSING FAC CARE, SUBSEQ

$115.42

$152.61

32.22%

99315

NURSING FAC DISCHARGE DAY

$71.37

$75.60

5.92%

99316

NURSING FAC DISCHARGE DAY

$93.84

$99.08

5.59%

99318

ANNUAL NURSING FAC ASSESSMNT

$76.22

$107.53

41.08%

99324

DOMICIL/R-HOME VISIT NEW PAT

$67.84

$56.18

-17.18%

99325

DOMICIL/R-HOME VISIT NEW PAT

$99.12

$81.65

-17.62%

99326

DOMICIL/R-HOME VISIT NEW PAT

$143.18

$134.47

-6.09%

99327

DOMICIL/R-HOME VISIT NEW PAT

$188.11

$175.29

-6.81%

99328

DOMICIL/R-HOME VISIT NEW PAT

$233.05

$206.38

-11.44%

99334

DOMICIL/R-HOME VISIT EST PAT

$52.43

$57.68

10.02%

99335

DOMICIL/R-HOME VISIT EST PAT

$82.82

$89.15

7.64%

99336

DOMICIL/R-HOME VISIT EST PAT

$127.32

$125.48

-1.45%

99337

DOMICIL/R-HOME VISIT EST PAT

$187.23

$180.16

-3.77%

99339

DOMICIL/R-HOME CARE SUPERVIS

$83.26

$88.75

6.59%

99340

DOMICIL/R-HOME CARE SUPERVIS

$115.86

$123.97

7.00%

99348

HOME VISIT, EST PT

$83.50

$102.83

23.15%

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 med@ipcbilling.com
         Patricia Nevala pat@ipcbilling.com

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

Please feel free to forward this newsletter to your staff and peers.

Forward to a Friend
 

Innovative Practice Concepts, LLC -- A full service medical billing company
Your Bottom Line is our Top Priority!