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Creating a Fee Schedule

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I set my fee schedule based on a percentage of Medicare. How do I price services that Medicare does not cover?

Question: I set my fee schedule based on a percentage of Medicare. How do I price services that Medicare does not cover?

Answer: Medicare does not assign a value to any codes that it doesn't cover. If you want to set your fees by Medicare/RBRVS, you actually have to make them up for these services. The best means to do this is by measuring time. Take your common codes, such as your E&M codes, and determine your average time per RVU. This may be five minutes per RVU. Then, evaluate how much time it takes you to perform the unvalued CPT code. If it's 20 minutes, then you could estimate it to be four RVUs. Of course, when you set your fee based on this system, make sure that it fulfills the most important criteria for setting your fees - that it exceeds the maximum allowable for the payers with which you contract.

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