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)
The documents below are in Adobe Reader format. You can obtain Adobe Reader for free by going to the Adobe web site.
 2007 Contracted Provider Fee Schedule
 Provider Notification AB1455
Claims Adjudication Policies and Payment Rules
Provider Dispute Resolution Request Form (this form can be filled out electronically then printed)
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.
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