Which Current Procedural Terminology (CPT) Codes Characterize the Practice?
Every medical group’s business is characterized by CPT codes used by the group’s business office for patient billings. Because fees associated with CPT codes constitute the group’s revenue sources, they are the payers’ basis for fee schedule negotiations. Therefore, it is very important for the group’s negotiator to proactively offer payers the CPT codes characterizing the group’s particular mix of patient services. Often, groups mistakenly leave it up to payers to present a sample of codes and fees representing proposed fee schedules for the group’s specialty. This puts the group negotiator at a significant disadvantage, because the negotiator must then use sample fees to extrapolate the fees of real interest to the group. Erroneous assumptions about payer RVS will lead to erroneous extrapolations. Further, payers tend to use different methodologies for determining fees for patient visits, ancillary services (e.g., lab, radiology, and physical therapy), and surgical procedures. For ex
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- Which Current Procedural Terminology (CPT) Codes Characterize the Practice?
