Children's Health Center Billing Practices

 

We're glad you've chosen Children's Health Center as your medical home. Insurance coverage and billing can be complicated. We want to make sure you have information about how we bill for the services we provide to help you understand any bills you may receive.

Insurance Terms to Know

• Copayment or copay: A fixed amount that you pay for certain health services before your insurance plan pays.
• Coinsurance: A part of your bill that is not paid by the insurance plan (usually a fixed percent of each amount paid by the plan)
• Deductible: An amount that must be paid before the insurance plan pays for covered services
  

Insurance Coverage

When we provide a service, we bill your insurance using a code that lets them know which service we provided. Each insurance plan's coverage is different and may cover all, some, or none of the charge associated with a code. Below are codes we commonly use. Please contact your insurance plan about coverage. Please note, this is not a complete list of codes.

Office Visit Codes 

• Preventive office visit (e.g., well child check-up): 99391, 99392, 99393, 99394, 99395, 99381, 99382, 99383, 99384, 99385
• Non-preventive office visit (e.g., sick or follow-up): 99212, 99213, 99214, 99215, 99202, 99203, 99204, 99205

Other Codes

• Oral health screen: 00191
• Fluoride varnish application: 99188 
  
• Developmental screen: 96110
• Mental/emotional screen: 96127
• Vision screen: 99173, 99174
• Hearing screen: 92551, 92587
• Extended hours: 90551
  
• Facility fee: UB04 REV 515 CPT code 99212

Preventive Services

Good healthcare for children and adolescents begins with well child check-ups. Check-ups and other services that help keep children healthy are preventive services. Our doctors and staff provide preventive services based on recommendations from the American Academy of Pediatrics (AAP). Because they are an important part of keeping children healthy, most health insurance plans cover preventive services. However, this is not true for all insurance plans. If an insurance plan does not cover these services, we still provide preventive services as recommended by the AAP and we must bill your insurance plan based on the actual services provided.

Additional Service Charge

Well child check-ups are preventive, routine visits. If your child is sick or if there is an issue that requires additional attention during a well child check-up, your doctor may need to provide an additional service. We bill your insurance for an additional, non-preventive service. Because the additional service is not preventive, your insurance plan's co-payments, coinsurance, or annual deductibles apply.

Extended Hours

Our regular business hours are Monday through Friday, from 8 am to 5 pm. For your convenience, we offer extended hours in the evening and on Saturday. We bill your insurance at a higher rate for visits in extended hours. Your insurance plan may cover all or just a part of this higher rate.

Facility Fee

Facility fees help to cover the cost of running our health center; this includes the cost of medications, equipment, educational resources, counseling, and staff. At each visit, we bill your insurance a facility fee in addition to fees for services provided. Insurance coverage for this fee may depend on your plan and annual deductible requirements.