Author Topic: Pricing for Hisppa Codes  (Read 1715 times)

Leslie Bartley

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Pricing for Hisppa Codes
« on: April 10, 2012, 04:02:15 PM »
Good Morning:

We are trying to locate the price we may charge for G0411 (Psychotherapy), Rev. Code 0914; G0176 (Activity Therapy), Rev. Code 0904; and G0177 (Patient Education and Training), Rev. Code 0942.  These codes are applicable according the CMS Manual Chapter 4, 260.1 and 260.1.1. 

We are a standalone CMHC doing a Partial Hospitalization Program.  We have just been approved for Medicare Part A and must complete an UB04 form for each of our clients.  We can't find anyone who can provide the price for these three services codes.

We would be most grateful for any Help.

Leslie E. Bartley, Ph.D.


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Re: Pricing for Hisppa Codes
« Reply #1 on: April 11, 2012, 12:20:50 PM »
you set your own rates but to see how much medicare allows go to the website and look under their fee schedule.


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Re: Pricing for Hisppa Codes
« Reply #2 on: April 12, 2012, 06:42:00 AM »
Most insurance carriers will not give out their allowed amounts or rates without a contract with the provider.  Most providers use the Medicare allowed amounts as a guide to set their fees.  They will take the allowed amount and make their fee(s) anywhere from 125% to 200%.  Personally 200% is very high, most average around 140% to 150%.

Hope that helps!
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