renumeration per patient?

[ctownmytown]

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I have searched for the answer to this question, but had no luck so I thought I would ask. There are plenty of threads related to the average annual salary for podiatrist, but I am wondering what a podiatrist receives on average per patient (net). I realize that this will depend a lot on what procedure is being done, but I was hoping that some practicing DPM could list some common procedures and the average amount that podiatrists make from each of them. Thank you so much in advance.

 

[PADPM]

This is a good question, but a difficult question to answer. There are many variables, especially geographic location, which I personally believe accounts for greatest differences.

The various reimbursements are too numerous to list, however there are some insurers that are relatively consistent across the country such as Medicare. Therefore, if you know any doctors, you can look up the fee schedule for common procedures performed and see the reimbursements.

It doesn't matter whether you find this information online, in a GP's office, orthpedic office or podiatrists office. An office visit reimbursement will be the same amount no matter who performs the procedure, and similarly a surgical procedure on the foot/ankle will be reimbursed the same no matter what specialty performs the surgery.

Other insurance companies will have a greater differential geographically in my experience. However, there is an annual survey conducted by Barry Block, DPM who also publishes this survey regarding average reimbursements, etc. He has a forum called PM news and a journal that publishes the results of this annual survey. I'm sure that if you google Dr. Block's name and contact him, he may be able to provide you with the results of the most recent survey.

By the way, the correct term is "reMuneration"!

 

[itswiggles]

- PADPM, based on your experience and knowledge which "geographic locations" work in the favor of DPMs the most???

 

[ctownmytown]

PADPM, thank you very much for your reply! I will check into the sources you mentioned.

 

[diabeticfootdr]

I have searched for the answer to this question, but had no luck so I thought I would ask. There are plenty of threads related to the average annual salary for podiatrist, but I am wondering what a podiatrist receives on average per patient (net). I realize that this will depend a lot on what procedure is being done, but I was hoping that some practicing DPM could list some common procedures and the average amount that podiatrists make from each of them. Thank you so much in advance.

Here is a list of procedures I've performed in the past 3 months and what I've been paid by Medicare (with the supplement). This is also defined as Medicare allowable fees. It is not secret information and I'm sure you can find out what the geographical differences are. Private insurers pay anywhere from 90 - 200% of Medicare allowable, depending on how you negotiate your contract with them. I think the average private insurer pays about 115%.

I live in California and have a practice based in wound care and limb salvage. So understand that when reading my list. I don't have information for routine care in the office, trauma in the OR, or elective surgeries.

Debridements (Clinic or OR)
11041 Skin $34.15
11042 Skin/Subcutaneous $45.34
11043 Muscle $243.29
11044 Bone $426.28
15004 Prepare Wound Bed/Foot $286.12
15002 Prepare Wound Bed/Ankle $186.58

Grafts (Clinic)
15340 Apply Apligraf $284.37
15365 Apply Dermagraft $314.88

Grafts (OR)
15175 Apply Integra $481.09
15120 Skin graft/Foot $654.31
15100 Skin graft/Ankle $594.06

Amputations (OR)
28825 Partial toe $349.58
28820 Toe $397.85
28805 TMA $636.60

Infections (OR)
27603 Incision and drainage/leg $390.42
28002 Incision and drainage/foot $321.72
28003 Incision and drainage/foot $578.37
28122 Partial excision bone/foot $216.53

Tendons (OR)
27606 Achilles tendon lengthening $301.74
27687 Gastrocnemius recession $473.19
27690 Tibialis anterior tendon transfer $649.78
29010 Toe tenotomy $221.45

Bone (OR)
28292 Keller arthroplasty $617.11
28750 Fusion 1st MTPJ $617.85
28730 Fusion midtarsal $862.35
28735 Fusion midtarsal with osteotomy $822.32

Wound Closure (OR)
13160 Revision and closure of wound $806.86
14040 Flap, Adjacent tissue transfer/foot $652.08
14041 Flap, Adjacent tissue transfer/foot $803.77
14350 Toe fillet flap $751.28

Evaluation (Clinic and Hospital)
99212 Level 2 Clinic Established Patient $26.41
99203 Level 3 Clinic New Pateint $78.33
99213 Level 3 Clinic Established Patient $52.02
99204 Level 4 Clinic New Patient $135.35
99214 Level 4 Clinic Established Patient $80.02
99221 Level 1 Inpatient Consultation $101.96
99222 Level 2 Inpatient Consultation $141.51
99223 Level 3 Inpatient Consultation $163.07

 

[ctownmytown]

diabeticfootdr, Wow! Thank you very much for that list. That information is extremely helpful.

 

[PADPM]

I really can not tell you exactly which geographic areas pay the highest amounts, since I don't have experience practicing all over the country. I would have to base my comments on anecdotal reports from my friends/colleagues, and I wouldn't count on that information as "gospel", since no one ever seems content with reimbursement.

As previously stated, I believe Medicare fees are relatively consistent across the country. Additionally, the majority of the time, you must take into consideration that reimbursements may be "relative", meaning that it could be consistent with the cost of living in the region.

For example the cost of living in California is greater than many other regions, therefore many insurance carriers may pay slightly greater fees. It's all relative.

You must also remember that some of the surgical fees that were listed by Dr. Rogers (diabeticfootdr) also include a global fee. So although the initial fee may sound high, there may be a global period attached to the procedure. A global fee means that there is a specific amount of time (10,30,60,90 days) included with the procedure when you can not bill for any follow up procedures related to the original procedure, barring any complication. That in essence dilutes the original fee if the procedure requires mulitple follow up visits.

These global fees are almost exclusively attached to surgical procedures and not to office visits, x-rays, etc. The more complicated the procedure, the longer the global fee (as a general rule).

Even routine foot care (only covered by most carriers for patients with compromised circulation, such as specific patients with diabetes, PVD, etc.), has limitations regarding reimbursement. When covered, most companies will only cover this service once every "61" days when medically necessary. Elective surgical cases, trauma surgery, etc., all pay under a system similar to the fees listed by Dr. Rogers that was developed years ago based on "relative value", which is supposed to take into account the complexity of the procedure, the time involved, follow up, the facility where the services were performed,overhead, etc.

So no matter what procedures are performed, they are all based on this same "relative value" scale (though at times it makes you scratch your head). And the surgical procedures Dr. Rogers listed, trauma surgeries, and elective surgeries all have global fees of varying lengths.