Effective 8/1/2020 the price (gross charge) for the above referenced services will increase. Calcium Scoring (CPT Code 75571) will increase from $129 to $351.94. CT Lung (CPT Code G0297) will increase from $315 to $567. These increases will allow Main Line Health to receive contracted reimbursement from payers who are now covering these tests. This includes IBC, Aetna, United, Medicare, Medicaid and possibly others.
A detailed review of these fee changes was conducted by an outside consulting firm as part of our annual Charge Master review process. It was determined that our current fee creates a disadvantage to Main Line Health as the current charge is far less than the ~ $240 we can expect from IBC and Aetna.
Note: Patients already scheduled for Calcium Scoring will be contacted by Central Scheduling to verify insurance coverage and/or to discuss financial options prior to testing.
Please read below for important information:
- Calcium Scoring and CT Lung are now covered by insurance (in most instances).
- We will learn more about specific payer reimbursement behavior by submitting insurance claims when it is determined that the service is covered.
- Process change:
- Ordering physician offices should verify that the test is covered by insurance before directing the patient to call Main Line Health Central Scheduling for an appointment.
- Central Scheduling will be asking patients for the specific CPT and ICD-10 codes when scheduling a patient for this service if an order is not directly placed in Epic.
- This is the standard process for scheduling all diagnostic testing.
- If the insurance will not cover the Calcium Scoring or Lung CT test, the following options are available.
- Patients can pay for the test out of pocket at the new self-pay discounted rate of $211.20 for Calcium Scoring and 340.20 for CT Lung.
- If your patient is unable to pay, the scheduler will direct the patient to the Hospital Financial Counselors to discuss assistance. The test will not be scheduled until the patient is financially cleared or until the Financial Assistance application is approved. The turnaround time for this application is less than 48 hours after obtaining the required documentation from the patient.
Patients referred from the Women’s Heart Initiative will follow the same process detailed above. Insurance will be billed where appropriate. Patients who are uninsured will be charged the discounted Self Pay rate. In the event of a financial hardship, the Financial Assistance program will be available.