Question

Dr. Ellen Zook, an allergist, is a participating provider with Phoenix Care and Medicare. She is a nonparticipating provider with Cirrus Health. Patients frequently receive allergy scratch testing, CPT code 95004, and are charged $470. In addition, Dr. Zook charges $65 for the average established patient office visit, CPT code 99213, and $70 for the average new patient office visit, CPT code 99203, and $477 for 95004.

Nils Hovik is an established patient and is covered by Phoenix Care through his employer. This specific group plan has neither a copay nor coinsurance. He has met his deductible of $250 for this year. He visited Dr. Zook for itching and congestion. The encounter form listed two procedures: office visit and allergy scratch testing. Dr. Zook submitted a claim to Phoenix Care. The allowed charge under PhoenixPlus is $62 for 99213, $65 for 99203, and $477 for 95004.

(1) What amount will Dr. Zook be reimbursed by Phoenix Care for each procedure? In total?

(2) What amount, if any, will Dr. Zook write off for each procedure? In total?

(3) What amount, if any, will be billed to Mr. Hovik for each procedure? In total?

Answer 1

Given, Nils Hovik is an established patient. Office visit for Nilis Hovik = $65 Allergy scratch testing cost = $470. Dr. Zook be reimbursed $65 for office visit and scratch testing. Total = $ (65 +470) = $535 2% write & 65 for office wisit scratch testing as patient is established patient. $ 470 for allergy Zook and & 470 for allergy an Total 3 $535 Mr. Horik will not be bill anythi bill anything his deductible of $250 for this year. as he has met Note: Xils Horik is hot a phoneix plus member.