Any suggestions or what do most doctors do?

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Apr 12, 2005
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Hi docs,

I currently have a lease at a commercial establishment doing eye exams and don't sell glasses or contacts. I have a question on how to set exam prices.

Since I'm at a commercial place, I realistically can charge around 60 dollars for an eye exam because if I charge more, then I will not be able to compete with the other commercial and private offices around me, therefore, no business. I take lots of vision insurances as well as medical. What I do currently is that I use a S code for cash paying patients ($60) and charge extra for DFE/VF screening ($30). When medical insurance patients come in I use 92004, of which I set around $140 to maximize my reimbursements with the insurance company. However, I would not charge extra for DFE since it is included in all 92 or 99 codes.

The exam itself is really no different, but of course I do have a medical chief complaint when billing medical. I understand this is probably not the most correct thing to do, but I can't realistically bill a private patient $140 for an eye exam, regardless if it includes DFE or not. And I would hate to bill just $60 for a 92004 or even a 92002 because I will be leaving a lot of money on the table. Can anyone please comment on what I can do in my situation to make things more legit and without losing money. Thank you

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#1) Stop charging extra for an effing DFE.
#2) Other than the DFE thing, this sounds more or less legit to me. An S-code is a different exam than a 92002/4, so you can set different charges for it.

Set your S-code at whatever you want (NO EXTRA FOR DFE)

92002 - $95
92004 - $140
92012 - $85
92014 - $ 120

Which, is basically what you're doing, as far as I can tell.
I agree to stop charging for DFE. It can become a medico-legal aspect as well. A lawyer could argue that a patient couldn't afford the DFE, which could have detected a Retinal detachment. Then a OMD will get on the stand, and say he would have done a DFE as a standard part of the examination without charging extra.

For a base exam with an OMD in my town is $200.

I've learned long ago not to be the lowest price in town. You'll attract patients that only want to see you for your price, and then expect you to give away services.