Calculate the average revenue for CPT 99215 the provider will receive based on the payment rates in Table 5.1

and the payer mix in Table 5.2. If the average cost to provide the patient visit is $64.00, will the provider need nonoperating revenues to cover its costs?

TABLE 5.1 Payment Rates for Physician Office Visits

	CPT Visit Codes
Payer	99211	99215
Charge/self pay	60.00	100.00
Medicare	39.50	54.90
Medicaid	29.90	35.40
Blue Cross	48.00	80.00
Managed Care-Giant	55.00	85.00
Managed Care-Sigma	42.00	70.00
Managed Care-Unity	52.00	65.00
Charity/No Pay	0	0

table 5.2 Calculating Average Reimbursement

Payer	CPT 99211	Payer Mix	Average Reimbursement
Charge/self pay	60.00	8%	4.80
Medicare	39.50	45%	17.78
Medicaid	29.90	5%	1.50
Blue Cross	48.00	15%	7.20
Managed Care-Giant	55.00	10%	5.50
Managed Care-Sigma	42.00	8%	3.36
Managed Care-Unity	52.00	7%	3.64
Charity/No Pay	0	2%	0
Average Reimbursement	40.80	100%	43.77