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.