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Office Visits, Copays and Deductibles

It is your responsibility as a patient to understand your insurance policy and guidelines.  An informed consumer can make wise purchase decisions.  We are unable to tell you how your insurance carrier will respond to claims submitted.

 Insurance Billing of Office Visits and Procedures 

According to the American Medical Association CPT 2009 coding guidelines, we are to use medical billing codes that most accurately reflect the services or procedures performed.  These codes are then sent to your insurance company for consideration.   

Office Visits   An office visit, as defined by the AMA, is the evaluation and management of health issues.  In other words, this involves only physical examination and discussion about your health concerns.   The level of code used is based on many factors including:  

  • History of the present illness (condition)
  • Physical examination
  • Medical Decision Making 

Some insurance carriers have copayments that are due at the time of service.  These copayments cover office visits only. 
Be informed:   any time you see a physician, it is a billable service. 

Procedures  As part of your medical care, a physician may recommend in office procedures to either diagnosis or treat medical conditions.  These procedures are billed using the correct AMA CPT codes, and may be billed in addition to the office visit.  As a consumer, you are invited to inquire about procedure costs prior to treatment.   Procedures are generally applied toward an insurance deductible and are not subject to office copays.   If tissue is removed and sent to a pathologist, you will be billed separately for their services.

If you have questions about our in office billing procedures, please ask to speak with the office manager.