Survey Report: What you charge vs what you get

October 22, 2001

Here's the latest update on fees and reimbursements in primary care--and the gaps between them.

 

Cover Story

SURVEY REPORT

What you charge vs what you get

Jump to:Choose article section...How practice size affects fee levels What doctors charge for office visits Charge ranges: Internists hold their own The range of fees for cardiologists Charges for hospital care   A

Here's the latest update on fees and reimbursements in primary care—and the gaps between them.

By Mark Crane
Senior Editor

With relatively few exceptions, reimbursements this year for medical services and procedures are flat or sinking. That's been true for at least five years, according to the latest Medical Economics Continuing Survey, which samples MDs and DOs in office-based private practice.

Once again, third-party payers give physicians less than half their fees for most CPT codes for major procedures and services. For example, cardiologists typically receive $30 of the median $65 they charge for an ECG with interpretation and report.

The decline in reimbursements in the surgical fields continues. Despite relatively modest fee increases, actual reimbursements fell yet again this year for ob/gyns, general surgeons, and orthopedic surgeons.

The news is better for office visits, but not by a lot. While actual payments still lag behind physician fees, there has been some improvement. On average, doctors receive about 75 percent of their actual charges.

General internists raised median initial office visit fees in all five CPT codes by an average of $5.40. Reimbursements were up $3 for 99201 and 99202, but remained the same for more-extensive visits. For established patients, internists raised median fees by $3.20 on average, while actual payments declined by about 40 cents. Median fees for ECGs rose by $5, while reimbursement stayed the same. The pattern was reversed for sigmoidoscopy: Internists raised their median charge by $3, but the median reimbursement climbed by $5.

Family physicians raised median initial office visit fees by $4 on average, while actual payments went up an average of $3. For revisits, fees rose by an average of $4.20, but reimbursement climbed by $3.80. For hospital care, however, FPs raised median fees by almost $6 per code, while reimbursement went up by an average of almost $7.

GPs' initial office visit fees rose in three codes and declined in two, for no change on average. Reimbursement was also unchanged. For revisits, median fees rose $1.80 on average, while actual payment rose by $1.60.

Pediatricians raised median initial office fees by an average of $6, while reimbursement rose $4.20. For established patients, the increases were $5.40 for fees and $4.40 for reimbursements. Median hospital fees rose by $1.67 on average, while reimbursement was $3 higher. Median fees rose 4 percent for three of pediatricians' four major services, but there was little change in reimbursement.

Invasive cardiologists raised median initial office fees by an average of $12.80, while reimbursement rose $6.70. For revisits, median fees increased by $5.60, while actual payment went up $7.25 on average. Noninvasive cardiologists raised median initial office fees by an average of almost $17 per code, but received only $6.50 in additional reimbursement. For revisits, median fees rose by an average of $8.25, while reim- bursements went up only about $3. For six major cardiology services we surveyed, median fees increased by 4 percent, but reimbursements declined or remained the same as last year.

Ob/gyns raised median initial office fees by an average of $8.40, but reimbursement increased $4.40. For revisits, median fees were up $1.40, while actual payments rose by $2. For nine major procedures, median fees rose by an average of 10 percent, while reimbursements declined by 3 percent.

How do your fees and reimbursement levels stack up against the norms set by colleagues in your specialty and size of practice? See the accompanying tables, and commentaries. For a description of how the survey was conducted, see "Earnings: Time to call a code?".

How practice size affects fee levels

 New patient (99204)Established patient (99213)
 FeeActual paymentFeeActual payment
Solo practice$135$91$60$45
2 doctors1351006248
3 doctors1501155747
4 doctors1551106545
5-9 doctors1401006247
10-24 doctors1501106047
50 doctors or more160—*72—*
Doctors in single-specialty groups1501116347
Doctors in multispecialty groups150996245
Doctors in salaried groups1421006545

 

What doctors charge for office visits

 New patient
9920199202992039920499205
Actual paymentFeeActual paymentFeeActual paymentFeeActual paymentFeeActual paymentFee
Cardiologists (invasive)$69—*$90—*$125$80$160$100$200$150
Cardiologists (noninvasive)65—*100—*128—*180113225150
FPs50$3870$569274125100162120
General internists5938785510070140100177125
GPs5036655079611007512595
Ob/gyns654085601077214591170120
Pediatricians50377050906612085150110
All respondents5538755510072140100175125
Participate with HMOs553877561007014298175120
No participation with HMOs503970589580132100165137
Participate with PPOs553875561007214098175125
No participation with PPOs503570519576135102165138
 New patient
9921199212992139921499215
Actual paymentFeeActual paymentFeeActual paymentFeeActual paymentFeeActual paymentFee
Cardiologists (invasive)$30—*$50$34$70$47$90$70$125$99
Cardiologists (noninvasive)—*—*50—*704510070140100
FPs30$2045345845846812098
General internists352048336546886412588
GPs302240345143755610075
Ob/gyns352550357045906412585
Pediatricians302145356045806012085
All respondents322046346045856412590
Participate with HMOs322046336245856312590
No participation with HMOs3021453560468568124100
Participate with PPOs322046346145856512590
No participation with PPOs3023453555458565125100

 

Charge ranges: Internists hold their own

 % charging it among
FeeGeneral internistsCardiologists (invasive)Cardiologists (noninvasive)
$80 or more17%11%14%
75-7971420
65-74202617
60-6491115
55-59763
50-54211510
40-4912611
30-39268
Less than $30442
Median fee (change since 2000)$60 (+9%)$65 (+16%)$65 (+8%)
Median reimbursement (change since 2000)32 (no change)29 (–3%)32 (+7%)
 % charging it among
FeeGeneral internistsFPsGastroenterologists
$275 or more12%8%12%
250-2744912
225-24910128
200-224151218
175-19915815
150-174162218
125-14915197
100-124746
Less than $100763
Median fee (change since 2000)$175 (+2%)$166 (–2%)$200 (+4%)
Median reimbursement (change since 2000)100 (+5%)__*90 (–2%)

 

The range of fees for cardiologists

FeeInvasive only
$700 or more13%
600-6999
500-59923
400-49916
300-39913
200-29914
Less than $20011
Median fee (change since 2000)$400 (–2%)
Median reimbursement (change since 2000)213 (–3%)
FeeAll cardiologists
$1,000 or more9%
800-9993
700-79910
600-69915
500-59912
400-49912
300-39912
200-29916
Less than $20010
Median fee (change since 2000)$500 (no change)
Median reimbursement (change since 2000)$150 (–25%)
FeeAll cardiologists
$600 or more8%
500-5996
400-49911
300-39916
200-29917
100-19920
1006
Less than $10016
Median fee (change since 2000)$200 (no change)
Median reimbursement (change since 2000)45 (no change)
FeeInvasive only
$2,000 or more8%
1,500-1,9996
1,200-1,49911
1,000-1,19913
800-99914
600-79911
500-59913
400-4996
300-39910
Less than $3007
Median fee (change since 2000)$800 (+6%)
Median reimbursement (change since 2000)300 (-3%)
FeeInvasive only
$600 or more7%
500-59918
400-4995
300-39913
250-2997
200-24910
150-19916
100-14913
Less than $10010
Median fee (change since 2000)$250 (no change)
Median reimbursement (change since 2000)—*

 

Charges for hospital care

 Hospital care, initial
992219922299223
FeeActual paymentFeeActual paymentFeeActual payment
FPs$106$79$143$113$181$150
Gastroenterologists11575155110200145
General internists12073155110200142
GPs966412296150120
 Hospital care, subsequent
992319923299233
FeeActual paymentFeeActual paymentFeeActual payment
FPs$60$42$80$60$105$85
Gastroenterologists6038755010075
General internists6040805610677
GPs5040655480—*
Pediatricians6043826011380

 

A Medical Economics Web Exclusive:
Office-visit fees around the country

Doctors in the West charge the most for new-patient office visits. Their Midwestern colleagues typically charge $15 less, but receive the most in actual payments. For revisits, Western doctors have the highest reimbursements.

 

New patient (99204)EastMidwestSouthWest
 FeeActual paymentFeeActual paymentFeeActual paymentFeeActual payment
FPs—*—*$125$107$125$98$140—*
General internists$150$95—*—*130100160—*
Ob/gyns—*—*135—*13895—*—*
Pediatricians10080—*—*12087141—*
All respondents1459013510513398150100

Participate with HMOs

14086135105

140

98150100

No participation with HMOs

150—*127113125100155100

Participate with PPOs

1409013510513598150104

No participation with PPOs

14582125—*125100165—*

 

New patient (99213)EastMidwestSouthWest
 FeeActual paymentFeeActual paymentFeeActual paymentFeeActual payment
FPs$65—*$56$45$57$45$60—*
General internists6547—*—*634565—*
Ob/gyns—*—*70487045—*—*
Pediatricians604560—*574560—*
All respondents6545594560456547

Participate with HMOs

6545604563456445

No participation with HMOs

75—*554456456550

Participate with PPOs

6545604560456545

No participation with PPOs

704750—*504570—*

 

A Medical Economics Web Exclusive:
How fees vary by type of community

All respondentsNew patient (99204)Established patient (99213)
 FeeActual paymentFeeActual payment
Inner city$127$80$65$40
Urban1501006545
Suburban1451006446
Rural1251005545

 

A Medical Economics Web Exclusive:
Typical charges and reimbursements in five specialties

 Fee (change since 2000)Actual payment (change since 2000)
Upper gastrointestinal endoscopy, diagnostic (43235)$500 (+1%)$220 (no change)
Liver biopsy, needle; percutaneous (47000300 (+9%)150 (+15%)
Dilation of esophagus, by unguided sound or bougie, single or multiple passes (43450200 (no change)100 (+11%)
Appendectomy (44950)$1,200 (no change)$569 (-5%)
Laparoscopy, surgical; appendectomy (44970)1,415 (+3%)600 (-1%)
Cholecystectomy (47600)1,900 (+3%)800 (no change)
Laparoscopy, surgical; cholecystectomy (47562)2,330 (no change)850 (no change)
Initial inguinal hernia repair, age 5 or over; reducible (49505)1,118 (-4%)475 (-6%)
Gastrectomy/partial, distal— with gastroduodenostomy (43631)2,500 (no change)1,100 (-8%)
Modified radical mastectomy (19240)2,200 (-3%)1,000 (no change)
Excision of cyst or fibroadenoma from breast tissue, one or more lesions (19120)721 (+3%)350 (-7%)

Circumcision, clamp, newborn (54150)

$100 (no change)

Total hysterectomy, abdominal (58150)2,600 (+4%)1,200 (-8%)
Complete OB care, routine, vaginal delivery (59400)2,500 (+4%)1,700 (+6%)
Complete OB care, routine, with cesarean section (59510)2,875 (+3%)1,800 (no change)
Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) (58120)682 (no change)285 (-5%)
Dilation and curettage, for induced abortion (59840)750 (+15%)350 (no change)
Dilation and evacuation for induced abortion (59841)807 (+8%)__
Laparoscopy, surgical, with fulguration of oviducts (58670)1,240 (+3%)570 (-5%)
Colposcopy (vaginoscopy);LEEP (57460)650 (+24%)260 (-11%)
Colles’ fracture, closed manipulation (25605)$750 (+11%)$400 (no change)
Open treatment of hip fracture (27244)2,750 (+5%)1,206 (+1%)
Knee arthroscopy with meniscectomy (29881)2,250 (+6%)835 (-7%)
Total hip arthroplasty (27130)4,560 (+1%)1,700 (-6%)
Diagnostic knee arthroscopy (29870)1,065 (+7%)474 (-5%)
Total knee arthroplasty (27447)4,848 (+8%)1,800 (-4%)
Arthrocentesis of knee (20610100 (+11%)65 (+16%)
History and examination of normal newborn (99431)$145 (+7%)$100 (+2%)
Immunization, DTaP (90700)3523
MMR virus vaccine, live (90707)50 (no change)36 (-3%)
Circumcision, clamp, newborn (54150)150 (+6%)100 (+5%)

 



Mark Crane. Survey Report: What you charge vs what you get.

Medical Economics

2001;20.

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