CPT Code 98960 is a patient self-management education and training code commonly billed for individualized instruction provided by a qualified nonphysician healthcare professional. In Florida PIP litigation, insurers have frequently argued that CPT 98960 is not reimbursable under the Medicare Part B Participating Physicians Fee Schedule because Medicare labels the code with a “Status B” […]
OPPS stands for Outpatient Prospective Payment System. It is a Medicare reimbursement methodology used to pay for hospital outpatient services. Instead of paying based strictly on a physician’s fee schedule, OPPS assigns services to payment classifications and reimburses based on predetermined rates. In simple terms: OPPS is one of Medicare’s official payment systems — and […]
How Geographic Location Directly Affects Your Reimbursement Medical reimbursement under Medicare and Florida PIP is not a single statewide amount. Instead reimbursement is based on Medicare fee schedule localities which adjust payment amounts depending on the county where the provider is located. These geographic adjustments directly affect how much an insurer is required to reimburse […]
When a patient receives medical treatment after a motor vehicle accident in Florida, the amount ultimately paid to the medical provider is often not the same as the amount billed. This is because insurers frequently reimburse providers based on fee schedules, rather than the provider’s full charges. Understanding how Medicare fee schedules works is essential […]
