Fee Schedule

Cost of Care at Smart Health and Wellness

First of all, we aim to ensure you never have surprise fees with this clinic. If you are charged for something by the clinic and this was truly not discussed with you beforehand, contact the clinic and we will work with you to straighten this out.

There are a few things to understand here before we go into specific fees:

  1. When a provider contracts with a health insurance company, the insurance company dictates what the provider will receive for each service. On the fee schedule below, you may notice a visit coded 99214 (established patient of moderate complexity) is charged at a certain rate, however, when a practice accepts insurance they agree to accept the insurance company’s payments as they deem fit. This means one company may pay $114 for this and another may pay $126 for the same service and any amount over this agreed upon amount is wrote off and not billed to the patient. This is why you see on your explanation of benefits (EOB) a charge for the service and it may say “$114 paid, $X not allowed due to over contractual obligation” and that $X just kind of “disappears” and is not collected or charged to anyone.

  2. Each service provided in a medical practice is assigned what is called a CPT or Evaluation and Management (E&M) code and this is how payment is determined. So the codes you see on the bill align with services provided and each code has a set amount charged.

  3. All patients must pay for services at the time of service, even if insurance is to be billed for reimbursement. All cash pay patients receive a cash pay discount down to the range in which the service is generally reimbursed by insurance.

  4. If you do not have insurance and the cost of care at our clinic is truly not affordable for you, please speak with the office manager to discuss other discounts we can offer if you qualify for financial assistance!

If you read the fee schedule below and are thinking, “Okay, so, all of these codes and I have no idea which one will be used for me so I still don’t know what I will have to pay,” read this:

  • New patient office visits are usually charged 99204 or 99205 depending on time and complexity.

  • Established patient office visits are charged 99213, 99214, or 99215 depending on time and complexity. 99214 is the most common code used.

  • Patients seeking weight management assistance will usually be charged 99401 in addition to their office visit. This indicates we discussed or addressed something that is considered preventative (like obesity management).

Fee Schedule As Follows:

87635 SARS-COV-2 COVID-19 AMP PRB

$100.00

96158 Health behavior intervention, individual, face-to-face; initial 30 minutes

$80.20

99202 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT SIMPLE/15 mins

$87.78

99203 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT STRAIGHTFORWARD/30 mins

$137.27

99204 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT MODERATE/45 mins

$204.14

99205 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT COMPLEX/60 mins

$269.78

99212 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT SIMPLE/10 mins

$68.45

99213 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT STRTFWD/20 mins

$109.95

99214 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT MODERATE/30 mins

$155.76

99215 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT COMPLEX/40 mins

$218.70

99382 INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS

$137.72

99383 INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS

$143.11

99395 PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION A…

$141.53

99396 PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION &…

$150.20

99397 PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION &…

$161.93

99401 Preventive medicine counseling and/or risk factor reduction intervention(s) prov…

$46.84

99402 Preventive medicine counseling and/or risk factor reduction intervention(s) prov…

$76.45

G0439 PPPS, subseq visit

$157.38

G0447 Face-to-face behavioral counseling for Obesity, 15 minutes

$22.07

G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (sar…

$19.32

U0001 CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel

$100.00

LAB PRICES

We provide lab draw services in the office. We do not run many of the serum and chemistry tests in office. The blood samples are prepared in the office, packaged, and sent to an outside lab. We receive excellent prices for cash pay labs through our contract with our partner lab. Basically, if they are able to charge my clinic account for the labs for my patients, this saves them the headache of chasing down payments from individual patients and they reward us for keeping it simple for them by offering us significant price discounts. We try to take advantage of this as much as we can so that we can offer great lab rates to patients of our area! For this reason, we allow the lab to charge our account for patients’ lab services and then we collect this amount from the patient.

We cannot guarantee pricing if labs are processed through insurance or if you have your labs at an outside facility because we cannot predict what your insurance will pay or how much the outside clinic will charge.

If you elect to have your labs drawn in the office and would prefer to pay cash for these instead of billing your insurance, you are waiving your right to seek insurance payment to cover the cost (and this is included in the consent you sign). Each lab draw service is charged $25 as a convenience fee in addition to the cost the lab charges to actually perform the test. This convenience fee is because all labs drawn in clinic are drawn by our providers and take time so this must be accounted for.