tci General Surgery Coding Alert - 2009 Issue 9

Reader Questions: Don't Let Medicare Set Your Fees

Question: I have a procedure code that one insurance allows $185.00, yet Medicare allows $26.00. Do I have to charge everyone the same amount, so that in this case I cannot charge the one payer more even though they allow more? Kentucky Subscriber Answer: Medicares fee schedule should not be the guide to your fee schedule. Just because Medicare only pays $26, you do not have to charge every other payer what the government entitlement program is paying. You can charge $185 to the other insurance if your fee for that procedure is $185. In fact, if...

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