Ok, I saw this from a post back in 2/10, but I still can't reconcile what Medicare Trailblazer automated system says is approved amount with what was paid, or what fee schedule shows.
90806 non-facility - fee schedule shows 93.69
automated system says 64.41 approved, $51.53 pd
Questions:
1)Pt. should owe difference between $51.53 and $93.69, correct?
2) Why does automated MC system say approved 64.41, then?
3) Also have an LCSW - ok, if MC allows 70.27 on 90806 (75% of the 93.69) and then pd 38.65, am I correct to show pt responsible for $31.62?
Thanks.
Also thanks to the post from 2/10 that mentioned that Mental Health is reimbursed at 55%. I've been going around in circles trying to figure out where the amounts pd were coming from. All this time I was thinking it was 50% of the allowed, and didn't realize that it was being reimbursed at 55% now.