Category: Billing

Understanding Billing Codes

CPT Codes

CPT Codes are used for individual providers, such as those in private practice. CPT Codes are billed on the CMS-1500 Form, also called the “HCFA.” Even if you do not accept insurance, if a client has a PPO insurance plan, they may receive some reimbursement for services. For clients with PPO insurance, you may print a “superbill” which has the CPT code on the form. You may also provide a patient with a pre-printed CMS-1500 form, which are available on Amazon.

Here are some examples of CPT Codes, with sample rates:

CPT CODE DESCRIPTION BILLING AMOUNT
0 none $0
90792 Psychiatric Diagnostic Evaluation (with Medical Services) $300
90833 ADD ON-30 Min Psychotherapy $50
90837 Psychotherapy 60 min (53+ min) $180
90838 ADD ON-60 Min Psychotherapy $100
90839 Psychotherapy (Crisis) $340
97813 Acupuncture with Electrical Stimulation – 15 Minutes $50
97814 Acupuncture with Electrical Stimulation – Additional 15 Minutes $50
99205 Psychiatry 60 min Follow-Up E&M $300
99215 Psychiatry 30 min Follow-Up E&M $150
G0434 Drug Testing, EtG/EtS Urine Alcohol $85
G0434 Drug Testing, Urine Drug Screen (DSC6309) $25

HCPCS Codes

Facility codes, also known as HCPCS Codes, are used by hospitals, intensive outpatient treatment centers, and other facilities. These codes are billed on the UB-04 form. UB-04 Forms are also available on Amazon. Most private practitioners will not need to use the UB-04 or do any facility billing.

20 Questions To Ask Yourself When Starting a Business

business doctors

Ask yourself these 20 questions to make sure you’re thinking about the right key business decisions:

1. Why am I starting a business?
2. What kind of business do I want?
3. Who is my ideal customer?
4. What products or services will my business provide?
5. Am I prepared to spend the time and money needed to get my business started?
6. What differentiates my business idea and the products or services I will provide from others in the market?
7. Where will my business be located?
8. How many employees will I need?
9. What types of suppliers do I need?
10. How much money do I need to get started?
11. Will I need to get a loan?
12. How soon will it take before my products or services are available?
13. How long do I have until I start making a profit?
14. Who is my competition?
15. How will I price my product compared to my competition?
16. How will I set up the legal structure of my business?
17. What taxes do I need to pay?
18. What kind of insurance do I need?
19. How will I manage my business?
20. How will I advertise my business?

Having a game plan that answers these questions will put you ahead of the pack.  This exercise may also bring up questions about whether private practice is the right choice for you.  Not everyone is cut out to work for themselves.

Private practice requires you to tolerate a certain amount of risk.  If this risk/reward equation is not exciting to you, a more stable form of employment may be a consideration.