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.

Monica Salenski is a new patient covered by Cirrus Health. She was seen by Dr. Zook for an office visit and allergy scratch testing.

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 Salenski for each procedure? In total?

Explanation / Answer

Answer: Dr. Zook will be reimbursed by Cirrus Health for each procedure is $(470+$70)=$540.

Answer: Dr. Zook will write off for each procedure is $135.

Answer: $470 will be billed to Miss Salenski for each procedure.

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