Setting fees at your optometry practice is never easy. I attached a spreadsheet that will help you to do this. There are many philosophies on how you will set your fees, check out a few in this article.
Fees to set
- Eye exam prices
- Contact lens exam prices
- CPT codes
- Accessory products
Considerations to setting fees
- Private pay patients
- Vision insurance patients
- Medical insurance patients
- Fees must be the same for every patient, you cannot have different patients pay different prices
- The percentage of each type of patient your office sees
First off, you need to determine what percentage of your patients are private pay vs. insured. Then find out what your highest insurance plan is reimbursing. Just call them and get their fee schedule for a range of CPT codes. You never want to set your fees lower than what the insurance plan is willing to reimburse to you. Why would you take less than what they are offering?
Personally, I found that Medicare was offering my office the highest reimbursement rate here in California, so I got their fee schedule and set my fees based on that. You can get your medicare rates in your area here.
Once you have the highest fees an insurance company will provide, make sure your fees are at or above that amount. Next, you must consider the fact that your private pay patients will have to pay these fees. You can’t do a global discount just because they are private pay, that is illegal to my knowledge.
At my office, we set our fees higher than Medicare reimbursement rates and private pay patients do not mind paying this. They feel our practice and our doctors are absolutely worth the money spent.
We set different CPT codes at varying fee rates. For example, a fundus photo is a higher markup rate than visual field is.
An example of high vs low paying CPT codes
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