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Provider Fee Schedule

For non-capitated non-Primary Care Physician services, members will be paid as follows:

Surgery:
110% of Tulare County RBRVS Medicare Rates
Radiology:
110% of Tulare County RBRVS Medicare Rates
E-M Medicine Codes:
110% of Tulare County RBRVS Medicare Rates
Other Medicine Codes:
110% of Tulare County RBRVS Medicare Rates
Maternity:
$1,700 normal and C-Section
Pathology:
$1.20 CRVS 25% professional and 75% technical anatomical only. Clinical lab capitated and not reimbursed by the IPA
Anesthesia:
$36.25 per ASA unit

Current Medicare Fee Schedule:

(Multiply the Medicare rate by the percent listed above to determine the rate of reimbursement)

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Reimbursement for Non-Contracted Providers:

Unless prospectively negotiated, non-contracted providers will be reimbursed at 110% of usual and customary rates.  The current Medicare fee schedule will be used as the basis for usual and customary.

Electronic Claims:

Please review the payer ID you have listed in your billing system and make sure that you are sending claims electronically to IP082 (zero-eight-two) for our commercial HMO plans (Blue Cross, Blue Shield, Health Net, & UnitedHealthcare) or to IP083 (zero-eight-three) for Humana Medicare Advantage. As a reminder Correct Coding initiative edits and CMS guidelines must be followed when billing Key Medical Group.