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DOCTROIT  Advocating for the cash paying patient  

Fee Information

The standard way that physicians are paid for services today is based on a very specific system known as HCPC (Healthcare Common Procedure Codes)  There is nothing simple about this system.  The book of codes to use is several hundred pages long.  Staff attend week-long programs to learn to determine proper codes for services rendered.  Every aspect of care you receive in a doctor's office is paid according to its HCPC code.  There are dozens of codes for mole removals, ten codes for office visits, combinations of codes for an immunization, etc.

We would like to state a definitive price for your services, but unfortunately, this can not be known in advance.  Physicians who sign up for DOCTROIT have agreed to a discount fee schedule for their patients.  Physicians price their service on DOCTROIT at the Medicare Fee Schedule or at some percent above the Medicare Fee Schedule.  During your visit the doctor will identify the services provided to you and determine the HCPC code.  They will then provide you with a bill based on their agreed to rates.  If you know the HCPC code for a particular item you can look up the Medicare fee yourself on their web site.  Generally you can expect the doctors office to know these rates after your service is provided.

Here are some sample codes for your review based on Medicare's payments in the Detroit Michigan Area.  Note, some doctors may charge a premium above these stated rates.  Some may charge a flat rate.  See their fee notes in the doctor listing.

New Patient Established Patient
Level HCPC
Code
New Patient HCPC Code Fee
Lowest 99201 $38.95 99211 $22.76
Modest 99202 $71.03 99212 $40.50
Average 99203 $106.21 99213 $57.31
Complicated 99204 $148.69 99214 $88.65
Highly Complex 99205 $188.07 99215 $129.05

Physical Exam: Prices for physical exams vary based on the age of the patient.

  New Patient Established Patient
Age HCPC Code Fee HCPC Code Fee
0-1 year old 99381 $109.59 99391 $83.35
1-4 years old 99382 $117.76 99392 $93.70
5-11 years old 99383 $115.44 99393 $92.54
12-17 years old 99384 $125.80 99394 $101.87
18-39 years old 99385 $125.80 99395 $103.04
40 - 64 years old 99386 $147.81 99396 $114.17
over 65 years old 99387 $159.86 99397 $125.44

Other items may be necessary during your visit.

Item

HCPC Code

Rate
Chest x-ray 71020 $40.43
Pulmonary Function Test 94010 $35.66
EKG 93000 $29.46
Minor excision (cryosurg) 17000 $65.44
TB Test 86580 $12.12
Allergies 95117 $21.42
Hearing Test 92552 $21.15

Injections: Your doctor may recommend injections for vaccinations or other purposes

*note: immunizations will also add a fee for administration and disposable supplies.