Author Topic: Varying prices for the same services??  (Read 2286 times)


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Varying prices for the same services??
« on: May 08, 2008, 11:02:27 AM »

Howdy! I am new to surgical and facility billing and am a little confused. I have two facility bills for two different patients however they have the same CPT codes, same date of service, same location and even the same diagnosis code. We bill using the CPT codes billed on the professional side, instead of using supply codes. This particular service included these CPT codes;
63655, 63685, 95972 and L8680.
The prices on the first three are the same, however the last one which is the HPCP code for a spinal neurostimulator, has a difference of over $10,000.00. I see alot of differences within the facility fees from patient to patient, despite the same CPT codes being used. Can someone explain this to me? My understanding of facility billing is you are billing for the supplies, use of the room, etc. How can the same services differ so greatly in price? For a supply code, shouldn't the charges be the same across the board? Both patients are workers compensation, so it's not a fee schedule or contracting issue. Does anyone have any insight on this?
Thanks. ???


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Re: Varying prices for the same services??
« Reply #1 on: May 08, 2008, 09:25:11 PM »
   What you are describing is very strange.  You eliminated all of the explanations I could come up with.  It they were small differences in the prices I wouldn't find it quite so odd, but $10,000?  I can't think of any reason that would explain such a high difference.  Is it possible that even though it is the same HCPC code, the actual equipment is not always the same?  Although that is pretty far fetched too.  I guess I'm just grasping!

If anyone has an explanation for this, please respond!

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Re: Varying prices for the same services??
« Reply #2 on: June 10, 2008, 05:37:12 PM »
Iím not clear on your question. Is the difference just the price comparison of the CPT codes or are you saying the difference in price is with the patients? Ie. One patient(insurance company) is being charged 10,000 more than the other patient? The law is pretty clear on billing the same amount across the board. I canít charge B/C 10,000 for a procedure and the patient a different amount. If the price difference is the CPT Codes the insurance company is only going to allow what it allows. Medicare wonít pay separately for spinal neurostimulator, anymore it is considered to be part of the payment within the CPT code.


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Re: Varying prices for the same services??
« Reply #3 on: May 27, 2009, 09:52:45 AM »
Just a suggestion.  Check the billing set up for these charges.  I could be set up to multiply by the number of units.   

Steve Verno CMBS, CEMCS

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Re: Varying prices for the same services??
« Reply #4 on: August 09, 2009, 08:10:51 AM »
Some hospitals were recently involved in a class action lawsuit and under OIG investigation for setting different levels of fees for the same service.  The lawsuit was regarding charging uninsured patients more for the same service than insured patients.  Some hospitals call this tiered billing. 

My brothers hospital bill (eyebrow cyst) for 7 days without any treatment (he was uninsured) was $76,000.  My hospital bill for 14 days was $350,000.  Me?  I had open heart surgery, so th cost would be different.  My other hospital bill for 7 days was $175,000  When I was born, my hospital bill for 3 days was $76.00 but that was in 1953.  That included the doctor bill, childbirth, room and board, nursing care, pharmacy, and meals. 
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