Acupuncture Fee Schedule & Insurance Coverage

ACUPUNCTURE FEE SCHEDULE & INSURANCE COVERAGE

A typical visit usually costs $80- $150. The exact amount will depend on which services you receive. If you do not have insurance, you may be eligible for a “time of service discount” when paying the same day as service. Please consult the chart below to view the cost for itemized services and feel free to contact me if you have questions about fees.

If you are using insurance, you can refer to the fee schedule chart below to see what charges will be billed to your insurance company. As a contracted in-network provider, I have agreed to receive an amount that is less than my normal fees for service. This amount is determined by your insurance company, and the actual amount they will pay (called the contracted rate) will be declared after your claim is processed.

If you have a copay, you will only be responsible for your copay amount regardless of charges shown on your statement. If you have a co-insurance instead of a co-pay, you will be responsible for a percentage of the final amount (contracted rate) determined by your insurance company. You will be invoiced for this amount by my office after your insurance claim gets processed (please note that this can take several weeks). If you have a yearly maximum dollar amount allowed for treatment, your insurance company will discontinue payment once that amount is satisfied and you will then be responsible for any uncovered visits.

Please contact your insurance company to learn more about your plan details and what is required of you. To assist you in understanding your responsibilities for payment, please see the below explanations.

DEDUCTIBLES If your insurance plan has a deductible, you are responsible for paying out of pocket until your deductible is satisfied. First, the visit claim must be processed and then you will receive a bill by my office for charges until your deductible is satisfied. After your deductible is met, you may be required to pay a copay or co-insurance on future visits as specified by your plan.

COPAYS After your deductible is satisfied, you may be required to pay a flat fee per visit if your insurance plan requires it. This fee is called a copay. Please refer to your plan details for this amount.

CO-INSURANCE After your deductible is satisfied, some insurance plans require a co-insurance instead of a copay. A co-insurance is a percentage of fees that you are responsible for paying. Please refer to your plan details for this amount. Once I submit a claim to your insurance company, they will determine the allowable amount (contracted rate) and calculate what your co-insurance amount will be. You will then be billed for this amount by my office.

For example, let’s say you have a co-insurance of 20% with no deductible. If I bill your insurance for CPT code 97810 (acupuncture – 15 minutes) & CPT code 97811 (acupuncture – additional 15 minutes) for a total of $114, your insurance company will adjust this rate according to their reimbursement schedule. If they decide the reimbursement rate for services is $90, your insurance company will pay $72 (80% of $90) and you will be responsible for paying $18 (20% of $90). You will receive an invoice from my office for this amount after your insurance claim is processed. MAXIMUM OUT-OF-POCKET Some insurance companies have a maximum amount that you can be charged out of pocket. Your co-insurance payments for care will be deducted from this amount (at their predetermined rate) and when it is satisfied, your insurance company will cover 100% of care for the remainder of the year.

MAXIMUM PAYMENTS Some insurance plans will only pay up to a certain dollar amount per year for care. Once this amount has been satisfied, your insurance company will not pay for any claims made and you will be responsible for any future charges accrued.

MAXIMUM VISITS Most insurance plans have a maximum number of allowable visits per year. Please inquire with your insurance company regarding number of visits allowed for acupuncture, and if those visits are combined with other services such as chiropractic or naturopathic care. It is important to note that if you have a very high deductible and a small amount of allowable visits, you may use up all your allowed visits before your deductible is satisfied. If this happens, your insurance company will not pay for any claims made.

FEES Below is a chart of my current fees which are subject to change*. These are the most common CPT codes that I bill for acupuncture services. If you receive statements from your insurance company, you may see these charges on your statement alongside the adjusted contracted rate.

97810 Acupuncture 15 minutes $65 97811 Acupuncture Additional 15 minutes $49 97813 Acupuncture with Electrical Stimulation 15 minutes $70 97814 Acupuncture with Electrical Stimulation Additional 15 minutes $55 97139 Cupping, Moxibustion, or Similar Attended Procedure $60 97140 Gua Sha, Tui Na Massage, Myofascial Release $49 97026 Infrared Moxibustion (Heat Lamp) 15 minutes $10 97802 Medical Nutrition $60 99201 New Patient Exam 10 minutes $59 99202 New Patient Exam 20 minutes $125 99203 New Patient Exam 30 minutes $200 99211 Follow Up Exam 5 minutes $35 99212 Follow Up Exam 10 minutes $75 *rates as of January 1, 2016

Please let me know if you have any questions about your coverage. In order to determine your plan requirements, and for use in submitting claims to your insurance company, I will need your insurance company name, member ID number, your full name, and your date of birth.

It is advisable for you to be in contact with your insurance company re: benefit information, deductible remaining, charges accrued, and continued eligibility, as any changes in coverage or unpaid claims due to ineligibility are your responsibility.

Blue Buddha Acupuncture 15969 B Reese Rd Lake Oswego, OR 97035 [email protected] (503) 855-9429