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90791 Payout

Stephanie B 3 years ago in Billing/Electronic Modules updated by anonymous 3 years ago 4

I have noticed that, besides UBH, the payout difference on a 90791 and a 90837 is only a few dollars. Have others noticed this? Should I be negotiating a higher payout on 90791s?

This depend on the insurance companies allowed amount for the service.  When appropriate, our providers bill a 90791 and the amount paid to us by insurance is around $30 more than a 90837.  

Are you asking if you should increase your fee for 90791?  Do  you charge the same fee for 90791 and 90837?

For whatever reason, besides UBH, are allowed amounts for 90791s are $2-$5 more than 90837s. I bill a different amount for each code- $230 for 90791s and $210 for 90837s.

It could depend on the provider's credentials as well.   I'd be interested in what the insurance company says if you were to call them?  They may just tell you to look through their medical  and reimbursement policies.  


The difference between our 90791 and 90837 fee is $50 

I would talk with your Optum contract manager.  We currently noted the same and have requested this amount be adjusted on our contract.  Waiting to hear the outcome.  It has been several weeks but Optum is not known to be the quickest responders.


Richard