Healthgram Fee Schedule Calculators
Healthgram pays a fixed payment to all medical providers for all covered services. Covered Healthgram payments are paid at 100% of the fee schedule, less specified copays. Healthgram members are not subject to deductibles or coinsurance limits.
|Professional fees by CPT® code:|
|Top fees by specialty:|
|Facility fees by DRG:|
Facility outpatient surgery, OPPS:
|Ambulatory surgery center:|
Professional fees are multiplied by a geographic cost-of-living index factor for each provider zip code. Facility fees are set using a DRG rate. Outpatient HCPCS codes are set using an OPPS APC amount. Ambulatory surgery fees are set using HCPCS codes assigned to global price group code.
The Healthgram Fee Schedule is subject to change without prior notice. Providers and patients should check this website prior to the service being rendered to verify current reimbursement amounts. Certain services are not covered as outlined in the member's specific Master Plan Document. Inpatient claims may be subject to outlier adjustments when the services exceed the maximum length of stay. Transplants and certain high-dollar procedures are subject to carve-out case rate reimbursement. This plan is not affiliated with any preferred provider network or any insurance company.
Any amounts billed in excess of the Healthgram payment are not covered under the plan document.
CPT® Copyright 2008 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of the CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT® is a registered trademark of the American Medical Association.
Geographic adjustment factors are copyright protected by Yale Wasserman®, DMD Medical Publishers Ltd.