Question

Using this fee schedule for three different payers for orthopedic procedures, complete the questions that follow.

1. A patient with BCBS PPO coverage had surgical knee arthroscopy with medial and lateral meniscectomy. The plan has an 80-20 coinsurance, with no copayment for surgical procedures. The annual deductible is met. What will the plan pay, and what amount does the patient owe?


2. A United patient has a high-deductible plan with a $1,200 deductible for this year that has not been met and 75-25 coinsurance. He has surgical knee arthroscopy with debridement. What will the plan pay, and what amount does the patient owe?


3. Another payer offers the practice a contract based on 115 percent of the Medicare Fee Schedule. What amounts are offered for the codes above?

Answer 1

1. Plan pays $933.78; patient owes $233.45

2. Plan pays $30.48; the patient owes $1210.16

3.

Code	Description	New Plan
29871	Knee arthroscopy, surgical	$557.82
29876	Major synovectomy	$671.84
29877	debridement	$632.02
29880	w/meniscectomy, medial + lateral	$714.39
29881	w/meniscectomy, medial OR lateral	$661.30