Medical Fees Increased Significantly in 2016

Based on an analysis of over 1 billion actual charges, the median fees for all CPT codes (excluding Anesthesia) increased  5.64% during 2016. Most medical professionals do not use all of the CPT code sections, but there are significant variations in the rate of increase for different sections of the CPT coding system.

Evaluation & Management Services      

Almost all providers use the E & M codes, and use them with higher frequency than codes for procedures and diagnostic tests. For all E & M CPT codes (excluding Newborn Care, Delivery/Birthing Room Attendance and Inpatient Neonatal Intensive Care), the median increase in fees was 7.00%.

For Newborn Care, Delivery/Birthing Room Attendance and Inpatient Neonatal Intensive Care services only, the median increase in fees  is 27.44%.

CPT Code Section Table with Median Percent Increases

The table below summarizes the findings of the analysis by CPT section. The most important result is that fees increased for sections of the CPT coding system.

CPT Code Section Median Percent Increase
Surgery Services  
Integumentary System 5.76%
Orthopedic Surgery 4.98%
Respiratory System 4.80%
Cardiovascular System Surgery 4.63%
Hemic And Lymphatic Systems 5.21%
Digestive System 5.81%
Urinary System 5.67%
Male Genital System 5.80%
Female Genital System 4.85%
Maternity Care And Delivery 6.03%
Endocrine System 1.50%
Nervous System 5.94%
Eye And Ocular Adnexa 5.81%
Auditory System 8.28%
Radiology (All Sections)                                11.45%
      Diagnostic Radiology 6.71%
      Diagnostic Ultrasound 5.01%
      Radiation Therapy 18.37%
Pathology And Laboratory                        12.53%
Medicine Services (All Sections)  10.22%
      Psychiatry 6.66%
      Cardiology Medical Services 10.35%
      Neurology & Neuromuscular Procedures 10.58%
      Chemotherapy 13.26%
      Physical Medicine 5.20%

What About Your Fee Increases?

Health insurance companies will never tell you your fees are too low. Your fee for a particular service or procedure could be significantly less than other physicians in the same area.

If your fees for a particular procedure or service are at the national/local median, then 50% of all providers are charging more than you and 50% are charging less. Where you want to be is around the 75th percentile.

A comprehensive review of your fees at least once a year is important to make sure your fees are neither too low or too high. The only way to determine where your own fees fall within a range of fees is by comparing your fees to a comprehensive database of fees based on actual charges, not surveys.

Unfortunately, some practices still charge less than the Medicare allowable…and Medicare and private payers will be happy to process claims based on the lowest amount billed. These practices are leaving significant money on the table for each code affected by poor fee calculation. Using a comprehensive fee resource that provides usual, customary and reasonable (UCR) fees as percentiles plus Medicare allowables and RVUs eliminates the guesswork for fee setting that may result in this error.

Medical Fees 2017, published continuously since 1989, includes a comprehensive introduction and listings for over 8,500 CPT codes with expanded descriptions, fees at the 50th, 75th and 90th percentiles, plus Medicare fees and relative values (RVUs). Also includes geographic adjustment factors to help you fine-tune the data to your geographic area of practice.

Use Medical Fees 2017 to

  • Review your fee schedule against national and local statistical norms
  • Set fees for new or never before performed procedures
  • Maximize your payments from Medicare and private carriers
  • Challenge low allowances and payments by health insurance companies
  • Review managed care contracts to determine if payments are fair and reasonable

Save 50% off with coupon code FEE-SAVER-50 when ordering online.

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