 Who will you bill?  How will you bill?  How do you decide how much to bill?  What else?

 Can you bill insurance? What are possible codes?  97533: Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes.  Medicare reimbursement $24.22 for each 15 minutes.  97124: Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)  Medicare reimbursement $  97113: Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises.  Medicare reimbursement $31.03.

 Can you bill insurance?  Yes, but they probably won’t pay for these services  Can you bill the patient directly?  Yes

 Certain services are not reimbursed by the patient’s insurance but are still valuable to provide  An example of these might be e-visits, or online consultations  Many providers bill the patient for these directly without submitting to insurance  For example, Mayo clinic charges $35 for an e-visit, but most insurances don’t pay, so the patient gives their credit card number for payment

 Another example of billing the patient directly are procedures that are considered “luxury” procedures, like Lasik vision correction surgery  The patient’s insurance does not pay for this procedure, but the patient values the service, and sees that it will benefit them, and so pays for it directly

 Consider costs  Start-up costs, e.g. dimmer light, eye pillow, etc.  Advertising costs  Cost of your time to provide the service  Cost of any additional personnel’s time  Cost of the overhead for your practice  Cost of any equipment

 Consider what others may be charging in your area  Consider what patients say they would pay  Consider what the “market” will allow

 If learning a technique will take a few sessions, consider having the patient pay for all sessions up front, but at a slightly discounted rate  If one or more techniques naturally fit together, consider offering training for both at a slightly discounted rate

 Define the “break point”  The point at which you cross over from simply making less profit, to having the service actually cost you money  Discount to above the break point