# Non-Medicare Fee Schedules



## suemt (Jun 18, 2012)

Does anyone know where to find fee schedules for commercial insurance plans in New York?  I know how to find the anticipated fees for Medicare, but not the other insurance companies.  

In particular, I'm looking for imaging studies (echo, carotid, sonograms, etc.)

Thanks in advance!

Sue


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## beckiw (Jun 18, 2012)

That's a tricky question.  Every insurance company has their own reimbursement schedule.  Some publish is freely - like Medicare.  In my state, Blue Cross is published as well, so is workers compensation.  But for most commercial carriers, this information is not freely published.  You can try the various websites for those carriers.  If you participate and have a log-in for their websites, it's possible the information is there.

If you participate, you can probably call and ask for a fee schedule for your specialty.  If you don't participate, they aren't likely to give it to you.

Good luck.


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## suemt (Jun 20, 2012)

OK, let's try another tactic.  How about if I list some procedure codes and if anyone in downstate NY has gotten these paid in this calendar year (2012) by any of these insurance plans, you tell me the allowed amount.  

Here's what I have so far:

Proc Code	Empire BC PPO (2012 DOS)

51798	
76536-TC	
76700-TC	71.88
76705-TC	
76770-TC	
93306-TC	212.32
93880-TC	141.21
93922	118.85
93925-TC	
93926-TC	
93930-TC	
93931-TC	
93970-TC	
93971-TC	
93975-TC	
93978-TC	

Proc Code	United Health Care (2011 DOS)

51798	
76536-TC	
76700-TC	
76705-TC	
76770-TC	
93306-TC	209.43
93880-TC	193.75
93922	102.68
93925-TC	
93926-TC	
93930-TC	
93931-TC	
93970-TC	
93971-TC	
93975-TC	
93978-TC	

Proc Code	UHC Empire Plan (2012 DOS)

51798	
76536-TC	
76700-TC	
76705-TC	49.95
76770-TC	122.90
93306-TC	350.00
93880-TC	189.90
93922	77.00
93925-TC	
93926-TC	
93930-TC	
93931-TC	
93970-TC	
93971-TC	
93975-TC	
93978-TC	

Proc Code	Oxford (2012 DOS)	

51798	
76536-TC	
76700-TC	
76705-TC	
76770-TC	
93306-TC	209.43
93880-TC	(specialist only is reimbursed)
93922	100.71
93925-TC	
93926-TC	
93930-TC	
93931-TC	
93970-TC	
93971-TC	
93975-TC	
93978-TC


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## suemt (Nov 26, 2012)

I was able to develop quite a bit of this information, so if anyone needs it, just let me know.


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## inc1961 (Oct 28, 2015)

I am doing research on CPT 93922, and CPT 95943 for a new client.
Are there any criteria for billing these two codes?  I have check local coverage determinations for NGS and Novitas (our Medicare MACs) but have come up empty handed.

Are there specific diagnosis codes that process favorably.  

Is there a specific POS that processes favorably?

Thanks in advance.


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