How Do I Fix It? Request copies of current contracts from
your top 10 Healthplans. Request copies of fee schedules for your
top 10 codes.
4/16/2008
Coastal Healthcare Consulting Group, Inc.
7
Sample of Reimbursement Comparison by Plan* PROCEDURE CODE
DETAILED CONSULT
CHARGE
MEDICARE
MEDI-CAL
WORK COMP
TRICARE TRIWEST
AETNA
BLUE CROSS
BLUE SHIELD
99213
ESTB VISIT
$135.00
$60.86
$24.00
$47.60
$42.48
$57.71
$56.31
$54.72
99243
DETAILED CONSULT
$312.00
$124.37
$59.50
$131.62
$93.61
$126.82
$128.45
$126.62
25605
CLOSED REDUCTION RADIUS
$1,346.00
$553.73
$271.41
$413.10
$516.18
$538.66
$542.08
$565.53
20610
INJECTION MAJOR JOINT
$178.00
$69.25
$45.79
$45.90
$46.87
$70.97
$56.28
$74.71
27130
TOTAL HIP
$3,332.00
$1,355.47
$759.12
$2,703.51
$1,355.47
$1,396.42
$1,995.04
$1,471.53
27447
TOTAL KNEE
$3,600.00
$1,459.37
$1,489.20
$2,514.56
$1,459.37
$1,509.01
$2,036.51
$1,589.56
29888
ACL REPAIR
$2,400.00
$1,144.83
$674.61
$2,296.53
$941.01
$1,005.53
$1,556.64
$1,058.93
29877
ARTHROSCOPY/DEBRIDE KNEE
$1,398.00
$576.74
$477.29
$1,133.73
$576.75
$586.21
$968.64
$616.42
73562
X-RAY KNEE
$84.00
$33.44
$23.38
$47.50
$33.34
$33.80
$34.38
$35.15
73218
MRI UPPER (73221)
$1,324.00
$547.39
$436.28
$695.88
$547.39
$500.00
$512.75
$543.54
73718
MRI LOWER (73721)
$1,324.00
$543.39
$436.28
$665.00
$543.40
$500.00
$512.75
$543.54
Q4083
HYALGAN J7317 (AWP-$94.00)
$283.00
$104.85
NOT COVRD
$105.66
$123.25
$109.54
$111.53
$497.00
$186.66
NOT COVRD
$198.09
$208.60
$166.00
$209.30
*ForQ4084 demonstration purposes only SYNVISC J7320 (AWP-$186.33) * For demonstration purposes only
4/16/2008
Coastal Healthcare Consulting Group, Inc.
8
4