Coding

  • 1.  76811/76812 reimbursement

    Posted 01-08-2024 15:25

    Quick question for 76811 and 76811;

    where can i find resources for reimbursement for MFM provider's  services ?

    what would be acceptable physician fees to charge for these studies?

    Thank you



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    Antonio Saad
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  • 2.  RE: 76811/76812 reimbursement

    Posted 01-08-2024 20:14

    Hi Antonio,

    One website that can help your query on reimbursement is the CMS website:

    'https://www.cms.gov/medicare/physician-fee-schedule/search/overview'

    You plugin the CPT (HCPCS) codes of interest and get a physician fee schedule summary.

     Best Regards,

    Fadi



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    Fadi Bsat, MD, FAIUM
    Chair, SMFM Practice Management Committee
    Past Chair, SMFM Coding Committee
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  • 3.  RE: 76811/76812 reimbursement

    Posted 01-08-2024 20:49

    Thank you!



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    Antonio Saad
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  • 4.  RE: 76811/76812 reimbursement

    Posted 01-13-2024 00:40

    It is difficult to find this type of information.  One thing you can do however is estimate it by using past data from the SMFM benchmarking studies.  Almost all contracts now are a percent of Medicare in regards to negotiation.  For each CPT code there is a corresponding number of RVU associated.   If you look at the benchmarking study on the SMFM website:  https://s3.amazonaws.com/cdn.smfm.org/media/1389/Slides.pdf  you can find the slide with the average reimbursement per RVU.   That will give you an average of commercial and Medicaid payments which will be overestimating Medicaid and underestimating commercial. Nonetheless when you multiply the $/RVU * the number of RVU per 76811 you will get an estimate.



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    Brian Iriye
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  • 5.  RE: 76811/76812 reimbursement

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    Posted 01-12-2024 01:58
    This post was removed