Interplan Health Group
Compensation Rates for Acu-Care Contract with Interplan Health Group
Check copy of actual contract for more details (see application for pdf document).
Interplan Health Group
coverage:
Group Health and Workers' Compensation and Other Payment Programs
(excluding personal injury and auto liability)
effective date: October 6, 2006
reimbursement rates:
Group Health
The rates below will be applicable for Group Health, Worker's Compensation, and other Payment Programs (excluding personal injury and auto liability).
Services shall be reimbursed at a rate of the lesser of 10% off billed charges or the rates as stated below.
a. Reimbursement Amounts are established by IHG and accepted by the IHG Payors. The IHG Reimbursement Amounts are based on Resource Based Relative Value Scale (RBRVS)*, locality 99. Reimbursement shall be 130% of the RBRVS allowable. For all unlisted procedures, Reimbursement shall be 80% of Provider's usual and customary billed charges. The CMS Ground Rules shall apply.
*RBRVS may be updated annually.
| SERVICE | PROCEDURE CODE | AMOUNT |
| Acupuncture, First 15 min. without electric | 97810 | $49.01 |
| Acupuncture, Reinsertion, Additional 15 min. without electric | 97811 | 37.81 |
| Acupuncture Electro Stim, First 15 min | 97813 | 52.52 |
| Acupuncture Electro Stim, Reinsertion, Additional 15 min. | 97814 | 42.37 |
| Office Visit Evaluation | 99201 | 47.40 |
| Office Visit Focused Expand | 99202 | 82.51 |
| Office Visit Detailed Expand | 99203 | 121.90 |
| Office Visit Complex Expand | 99204 | 184.85 |
| Office Visit or Other Outpatient Visit | 99211 | 27.01 |
| Office Visit Established Patient | 99212 | 48.95 |
| Office Visit Established Expand | 99213 | 79.12 |
| Office Visit Established Complex | 99214 | 119.81 |
| Hot and Cold Treat (one area) | 97010 | 6.45 |
| Neuromuscular Re-education | 97112 | 36.82 |
| Unlisted Therapeutic Procedure | 97139 | 21.06 |
Applicable for Workers' Compensation Cases
For States with a fee schedule established by a state or governmental entity, 15% discount off of the rate or fee established, or the negotiated rates whichever is less.