Dr. Ellen Zook, an allergist, is a participating provider with Phoenix Care and

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.

Parminder Singh is an established patient also seen by Dr. Zook for an office visit and allergy scratch testing; however, she is insured by Cirrus Health. The allowed charge under Cirrus Health is $58 for 99213, $61 for 99203, and $420 for 95004.

What amount will Dr. Zook be reimbursed by Cirrus Health for each procedure? In total?

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

What amount, if any, will be billed to Miss Singh for each procedure? In total?

Explanation / Answer

420 + 58 = $ 478 is the amount reimbursed by cirrus health to Dr. Zook

50 (470 - 420) + 7 (65 - 58) = $ 57 is the amount written off by Dr. Zook

470 + 65 = $ 535 is the amount charged from Miss singh for each procedure

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