Saturday, August 28, 2010

Does consult code accepted by Medicare HMO

Consults codes and Medicare HMOs



     Medicare HMO plan does not cover the consultation service.

Insurance name
1 Medicare
2 Humana (HMO)
3 Freedom Health
4 AVMED
5 Advantra Gold plus ( Coventry )
6 Universal Health
7 Wellcare
8 AARP Medicare completed
9 UHC (HMO)
10 Polk County
11 PUP
12 QHP
13 Amerigroup
14 Citruscare

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download