Medical Billing Forum
Billing => Billing => : June May 28, 2015, 03:36:00 PM
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Hello, I'm sure I have seen this answered before but I cannot locate it. For Aetna chiropractic services we are contracted at a certain rate for each CPT code. The two we use are 98941 for $45 and 98940 for $35, both for spinal manipulations but the first is for two regions, the second is for one. My question is this: The patient has a CPT code billed for 98941, we charge $45.00 the patient has a $40.00 co-pay. The contracted rate for 98941 with Aetna is only 23.16, of which Aetna pays 3.16. Wouldn't the co-pay we are allowed to charge only be $20.00 because the contracted rate is only $23.16. I have spoken to several different Aetna representatives and have received different information. I believe we can only charge the patient the contracted rate. Is this correct?
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If the doctor/chiropractor/office has a contract with aetna you may only collect on the appt, from both the insurance and the patient, the allowed amount. Total allowed amount is all you may collect.
Barbara
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Thank you, after talking with an Aetna representative that told me I should be collecting the $40.00 co-pay I started to question myself. I knew I was processing it correctly!