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Calculate the average revenue for CPT 99215 the provider will receive given the payment rates in Table 5.1 and the following payer mix. If the

Calculate the average revenue for CPT 99215 the provider will receive given the payment rates in Table 5.1 and the following payer mix. If the average cost to provide the patient visit is $64.00, will the provider need nonoperating revenues to cover its costs?

Payer Payer Mix
Charge/self pay 8%
Medicare 45%
Medicaid 10%
Blue Cross 15%
Managed Care-Giant 10%
Managed Care-Sigma 5%
Managed Care-Unity 4%
Charity/No Pay 3%
100%

Table 5.1

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

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