Out-of-Network Provider Charges for CPT Consultation Codes 99215 & 99244 Greatly Exceed Medicare Reimbursement

OPEN MINDS Weekly News Wire Strategic Health Care News In 2008, out-of-network provider charges varied widely across the United States for the same procedures; some out-of-network provider charges were hundreds or thousands of times higher than Medicare reimbursements. Outpatient visits and consultations—Current Procedural Terminology (CPT) codes 99215 and 99244—were among the procedures with the greatest claims divergence from Medicare reimbursements. Of the 30 most populous states, 26 reported out-of-network physician claims for CPT code 99215 among the top 10 highest charges exceeding Medicare reimbursement. In 13 states, out-of-network physician claims . . .