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CPT Coding Changes


1.  Patient-based web site to check out CPT billing rates by zip code

Posted Sep 06, 2013 3:48 PM
This message has been cross posted to the following eGroups: CPT Coding Changes and All-Purpose Discussion Forum .
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Dear Colleagues,
I recently learned of this web-site in which the health care consumer can type in a zip code and see what various CPT codes are being billed and reimbursed at and what the consumer is left with for out-of-pocket co-pay.  http://www.fairhealthconsumer.org/medicalcostlookup/compare.aspx

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Mary Moller
Associate Professor, Specialty Director-Psychiatric Nursing
Yale University School of Nursing
New Haven CT
(203) 389-4277
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2.  RE:Patient-based web site to check out CPT billing rates by zip code

Posted Sep 06, 2013 4:29 PM
Mary,

I looked at this site as well.  I input numbers into the zip and CPT codes  and was surprised by how high the numbers returned. 

I'm curious to know what other people think about it too.


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Romnee Auerbach ANP, PMHNP-BC
New Perspectives Center
Salem, OR 503-316-6770 (work)

OR-APNA Board Member
Portland, OR

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3.  RE:Patient-based web site to check out CPT billing rates by zip code

Posted Sep 07, 2013 9:32 PM
The reimbursement rates seem better than what we would typically expect. I am guessing that the reimbursement shown for the E&M codes (e.g. a 99214) is for all physicians, not APRNs, and not specifically psych/mental health practitioners at any level. What do others think?

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Tamara Hammer
Boston MA
(617) 742-9876
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4.  RE:Patient-based web site to check out CPT billing rates by zip code

Posted Sep 08, 2013 12:59 PM
As an interesting sidenote to CPT reimbursement, following is the compensation* paid to the top executives of  health insurance and pharmacy companies.  (Source is NYTimes 6-30-2013)

CVS Caremark               $18,119,843
United Health Group      13,887,455  (4% increase from 2012)
Aetna                                  13,252,351  (26% increase)
Cigna                                   12,758,410  (33% decrease)
Express Scripts                 12,754,690 (50% increase; did you notice the exceptional service they offer since merging with medco?)
Walgreens                          12,022,110  (1% decrease)

*includes base salary + cash bonus + perks/other +stock awards + option awards

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Cheryl Waskiewicz APRN
Orange CT
(203) 988-7895
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5.  RE:Patient-based web site to check out CPT billing rates by zip code

Posted Sep 08, 2013 2:48 PM
The E&M codes have been used by primary care physicians and NPs for many years now. Physicians get the 100% reimbursement and NPs are less, as it has been for over 20 yers!

Having been a part of the Work Group that facilitated the ability for psych NPs and physicians to bill E&M codes, as a true reflection of what we do in practice, it's good to hear that we have gotten past most of the initial responses and that reimbursement is better!

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Sandra Cadena, PhD, APRN
Professor
Walden University, Florida International University & Universidad el Bosque,South America
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