Author Topic: Reimbursement based on taxonomy  (Read 517 times)

10key

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Reimbursement based on taxonomy
« on: January 27, 2018, 11:02:11 PM »
Hi, I'm curious if there is any difference in reimbursement rates (from Medicare or private insurance) for the same billing codes if the physician's taxonomy is "208D00000X - General Practice" versus "207R00000X - Internal Medicine"  I see higher copays for physicians with the IM taxonomy compared to  physicians with the GP taxonomy, when both are board certified in internal medicine and practice as internists in the same office, but wasn't sure if there was a difference in amount reimbursed.

Thanks!

kristin

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Re: Reimbursement based on taxonomy
« Reply #1 on: January 29, 2018, 09:32:10 PM »
To my understanding, insurance companies post fee schedules, and the things that change reimbursement in those schedules are location/POS, participation in the insurance, and certain modifiers like 26, TC, and 80. So far as I know the taxonomy code of the doctor has nothing to do with the fee schedule reimbursement. It will change the copay, though, depending on the insurance/policy. For instance, some policies have a $20 copay for a PCP, and $40 for a specialist.

10key

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Re: Reimbursement based on taxonomy
« Reply #2 on: January 30, 2018, 09:55:56 AM »
Thanks for the response!  Is it accurate that a "Level 3 office visit" for a cardiologist is charged the same as it is for an internist? 

kristin

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Re: Reimbursement based on taxonomy
« Reply #3 on: January 30, 2018, 10:12:15 AM »
Yes. If Medicare for instance allows $100 for a 99213 done in a office setting, that is what they allow, regardless of what specialty the doctor is.

The only insurance I can think of that has different fee schedules based on specialty that I have ever dealt with is Medicaid. Possibly WC also, but I don't bill WC claims.