FEE SCHEDULE
No one enjoys receiving surprise bills. This fee schedule is provided so that you will be aware of all charges that can be accrued for services rendered and provided. This fee schedule is updated regularly. A copy of this fee schedule can be provided to you at any time at your request.
| CPT Code | Description | Professional Fee | Prompt Pay Fee* |
|---|---|---|---|
| E/M | |||
| 99202 | NP OV 15+ minutes | $146.20 | $35.00 |
| 99203 | NP OV 30+ minutes | $226.44 | not available |
| 99204 | NP OV 45+ minutes | $335.92 | not available |
| 99205 | NP OV 60+ minutes | $443.36 | not available |
| 99212 | EP OV 10+ minutes | $114.24 | $35.00 |
| 99213 | EP OV 20+ minutes | $182.24 | not available |
| 99214 | EP OV 30+ minutes | $257.72 | not available |
| 99215 | EP OV 60+ minutes | $361.08 | not available |
| CMT | |||
| 98940 | CMT Spinal 1-2 region | $55.76 | not available |
| 98941 | CMT Spinal 3-4 region | $80.24 | $50.00 |
| 98942 | CMT Spinal 5 regions | $104.04 | not available |
| 98943 | CMT Extraspinal 1+ regions | $53.04 | $10.00 |
| THERAPY | |||
| 97014 | Electrical Stimulation | $25.16 | $10.00 |
| G0283 | Electrical Stimulation | $25.16 | $10.00 |
| 97110 | Therapeutic Exercises | $59.84 | $10.00 |
| 97140 | Manual Therapy | $55.08 | $10.00 |
| OTHER | |||
| 99080 | Special Reports | $100.00 | not available |
| S9981 | Medical Records Copy Fee | $75.00 | $35.00 |
| 97124 | Massage Therapy | $25.00 per 15 minute unit | 4+ unit sessions discounted |
*We offer a Prompt Pay Fee for all patients by request, in lieu of insurance coverage. Insurance cannot be used when opting for a Prompt Pay Fee. If you opt to utilize the Prompt Pay Fee and fail to provide payment at the time services are rendered, you will be responsible for and billed 100% of the professional fee. Fee schedule updated 4/10/2024.
Questions regarding this fee schedule may be directed to our office at (520) 877-2666.
What is a CPT® code?
CPT is designated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.
What are E/M codes?
E/M services represent a category of CPT codes called Evaluation and Management. E/M services are a type of patient encounter between a physician and a patient seeking medical advice and care for symptoms, conditions, illnesses, or injuries. Commonly, E/M services are face-to-face encounters between the provider and patient. There are different levels of E/M codes, which are determined by the complexity of a patient visit and documentation requirements.
What are CMT codes?
As explained by CPT guidelines, Chiropractic Manipulative Treatment (CMT) is a form of manual treatment to influence joint and neurophysiological function. CMT services are represented by a category of CPT codes used to indicate the number of spinal regions manipulated. Spinal regions as defined by CPT are: Cervical, Thoracic, Lumbar, Sacral, and Pelvic. Extraspinal (non-spinal) regions as defined by CPT are: Head, Upper extremities, Rib cage, Abdomen, and Lower extremities.
What is Therapy?
Therapeutic procedures are modalities (specific types of treatment) that can be used in conjunction with CMT to assist with a variety of conditions or injuries.
massage policy
Your well-being is very important to us. Our goal is to provide quality health care to all our patients in a timely manner. We do understand that sometimes unexpected delays or emergencies can occur. Please be aware of our policy regarding missed appointments. Massage policy updated 4/10/2024.
Why do we have a Massage Therapy Policy? No-shows, late arrivals, and cancellations inconvenience not only our providers, but our other patients as well. When you book your appointment, you are holding a space on our calendar that is no longer available to our other patients.
What can I do? In order to be respectful of your fellow patients, please call our office at (520) 877-2666 as soon as you know you will not be able to make your appointment.
Cancellation Policy
Cancellation is free up to 24 hours in advance. Appointments are in high demand and your advanced notice will allow another patient access to that appointment time. New and/or first appointments that result in a no show or late cancellation will be charged 100% of the scheduled fee; otherwise, for existing clients after 24 hours a 50% late cancellation fee will be charged.
Late Cancellations/No-Shows
A cancellation is considered late when the appointment is cancelled less than 24 hours before the appointed time. A no-show is when a patient misses an appointment without cancelling. In either case, we will charge the patient a missed appointment fee as outlined above.
How to Cancel Your Appointment
If you need to cancel or reschedule your appointment time, please call us at (520) 877-2666. If necessary, you may leave a voicemail message. We will return your call as soon as possible if requested. If you are signed up to receive text message reminders, you can easily cancel by text message by following the instructions on your original text. Please do not send cancellations by email, they are not able to be accepted at this time.
Appointment Reminders
As an added convenience, our office offers text message reminders. If you would like to sign-up for this service, ask any member of our front desk to opt-in. In addition to this convenience, you can easily cancel an appointment by text message by following the instructions on your original text. Remember, a 24-hour notice is always required for any cancellations or appointment changes.
records request & release
The are many reasons medical records may be requested. A patient has a legal right to view and/or request a copy of their medical records. The following policy was put into effect for our office to abide by HIPAA requirements as well as to allow the patient to assert their rights.
How may a patient view their records? A patient may request to schedule an appointment to view their records at any time. A member of the staff must be present with the patient at all times to ensure records are not tampered with or removed.
How may a patient request a copy of their records? A patient may request a copy of their medical records at any time by completing an Authorization for Protected Health Information form. The form must be completed with no blank spaces.
Is there a charge to copy records? Arizona law allows physicians to charge a reasonable amount for the cost of copying and mailing records.
How long does it take to process a request for medical records? Arizona law states we must process requests for records within 30 days of the request. Records may be faxed, mailed, or picked up.
Who else may request medical records? Other physicians, insurance companies, insurance carriers, and attorneys may request records at any time.
Is there a charge when other physicians, insurance companies, insurance carriers, and attorneys request records? Records requested by other physicians for continuing care can not be charged. Insurance companies, insurance carriers and attorneys may be charged per request, payable in advance. In some cases, health insurance companies which we are in network with can not be charged for records.
How can others request medical records? A signed request on letterhead or other office form from the requesting physician or facility, a Medical Authorization form signed by the patient, Subpoena of the court, Record’s Retrieval service.
Can a patient request records be sent to someone else? A patient may complete an Authorization for Protected Health Information with the name of the receiver on the request. Charges do not apply if the receiver is a physician, doctor office or hospital, and for the purposes of continuing care.