Customized Fee Analyzer. Fee information for your area and specialty CUSTOMIZED REPORT FOR: General Practice / Primary Care
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1 Customized Fee Analyzer Fee information for your area and specialty CUSTOMIZED REPORT FOR: General Practice / Primary Care 2525 Lake Park Blvd. West Valley City, Utah #020112
2 Contents Introduction...1 Using the Analyzer... Analyzer Worksheets...13 Professional & Technical Splits of Global Services...23 Anesthesia Units, Follow-up Days, & Surgical Assistants...31 Fee Data Optum360, LLC CPT 201 American Medical Association. All Rights Reserved. Data only 201 FAIR Health, Inc.
3 Using the Analyzer In the introduction, a number of applications were listed to illustrate ways that the Analyzer data might be used. In this section, some of these applications are described in more depth. However, before beginning this analysis and adjusting your fees, consider the following: 1. How will the new fees compare with what payers are willing to reimburse? 2. How will your patients react to a change in charges? 3. Do the new fees accurately reflect the cost and worth of your services? 4. Realize that you may be restricted in adjusting some fees by Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) contracts, as well as Medicare and workers compensation fee schedules. 5. Because fee ranges in the Analyzer are based on the first three digits or groups of the first three digits of ZIP codes, you need to assess where your locale stands in relation to others in this three-digit area. Initial Comparison of Current Fees to Fees Initially, you may want to compare a few of your most frequently reported services to get an idea of where your current fees fall when compared to others in your area. You can compare the data to all seven percentiles or, initially, you may want to select only two or three percentiles. Step One Select procedure codes for all types of services performed, including evaluation and management, surgery, radiology, laboratory, and medicine. Step Two Using a spreadsheet, list the following items in separate columns: Column 1 Column 2 Column 3 Columns 4 10 CPT code Current fee Medicare allowable Analyzer fees at the 50th, 60th, 5th, 80th, 85th, 90th, and 95th percentiles 201 Optum360, LLC CPT 201 American Medical Association. All Rights Reserved. Data only 201 FAIR Health, Inc.
4 Page: 69 CPT CodeMOD Sub Description BR Medicare Allowable 50th 60th 5th 80th 85th 90th 95th 1261 DESTRUCTION MAL LESION TRUNK/ARM/LEG CM DESTRUCTION MAL LESION TRUNK/ARM/LEG CM DESTRUCTION MAL LESION TRUNK/ARM/LEG CM DESTRUCTION MAL LESION TRUNK/ARM/LEG CM DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/< DESTRUCTION MALIGNANT LESION S/N/H/F/G CM DESTRUCTION MALIGNANT LESION S/N/H/F/G CM DESTRUCTION MALIGNANT LESION S/N/H/F/G CM DESTRUCTION MALIGNANT LESION S/N/H/F/G CM DSTRJ MAL LES S/N/H/F/G LES DIAM > 4.0 CM DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/< DESTRUCTION MAL LESION F/E/E/N/L/M CM DESTRUCTION MAL LESION F/E/E/N/L/M CM DESTRUCTION MAL LESION F/E/E/N/L/M CM DESTRUCTION MAL LESION F/E/E/N/L/M CM DESTRUCTION MAL LESION F/E/E/N/L/M > 4.0 CM CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE CHEMICAL EXFOLIATION ACNE PUNCTURE ASPIRATION CYST BREAST PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX BIOPSY BREAST OPEN INCISIONAL I&D SOFT TISSUE ABSCESS SUBFASC BIOPSY MUSCLE SUPERFICIAL BIOPSY MUSCLE PERCUTANEOUS NEEDLE BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC INJECTION SINUS TRACT DIAGNOSTIC REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP , INJECTION THERAPEUTIC CARPAL TUNNEL INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS INJECTION SINGLE TENDON ORIGIN/INSERTION INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURSA ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA ASPIRATION&/INJECTION GANGLION CYST ANY LOCATION ELECTRICAL STIMULATION BONE HEALING NONINVASIVE ELECTRICAL STIMULATION BONE HEALING INVASIVE ,014 1,050 1,126
5 Page: 86 CPT CodeMOD Sub Description BR Medicare Allowable 50th 60th 5th 80th 85th 90th 95th 0328 TC RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH UNI RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH UNI G RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH BI TC RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH BI RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH BI G RADIOLOGIC EXAMINATION NECK SOFT TISSUE TC RADIOLOGIC EXAMINATION NECK SOFT TISSUE RADIOLOGIC EXAMINATION NECK SOFT TISSUE G RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS TC RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS G RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL TC RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL G RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL TC RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL G RADEX CH 2 VIEWS FRNT&LAT APICAL LORDOTIC PX TC RADEX CH 2 VIEWS FRNT&LAT APICAL LORDOTIC PX RADEX CH 2 VIEWS FRNT&LAT APICAL LORDOTIC PX G RADEX CH 2 VIEWS FRONTAL&LATERAL OBLIQUE PRJCJ TC RADEX CH 2 VIEWS FRONTAL&LATERAL OBLIQUE PRJCJ RADEX CH 2 VIEWS FRONTAL&LATERAL OBLIQUE PRJCJ G RADEX CHEST COMPLETE MINIMUM 4 VIEWS TC RADEX CHEST COMPLETE MINIMUM 4 VIEWS RADEX CHEST COMPLETE MINIMUM 4 VIEWS G RADEX CHEST SPECIAL VIEWS TC RADEX CHEST SPECIAL VIEWS RADEX CHEST SPECIAL VIEWS G RADEX RIBS UNILATERAL 2 VIEWS TC RADEX RIBS UNILATERAL 2 VIEWS RADEX RIBS UNILATERAL 2 VIEWS G RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS TC RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS G RADEX RIBS BILATERAL 3 VIEWS TC RADEX RIBS BILATERAL 3 VIEWS RADEX RIBS BILATERAL 3 VIEWS G RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS TC RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS G RADEX STERNUM MINIMUM 2 VIEWS
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