More 96110 Payment Details

OK, I think I have written about the 96110 more than any other specific subject!

First, big thanks go out to Igor for getting this data for me. Sure, he deserves a raise...we all do.

The list below should not be considered a 100% accurate report of which payers, by state, cover the 96110 (or 96111, for that matter) for two reasons:

  • First, as noted yesterday, these only reflect charges for which payments were made.  They could, conceivably, reflect payments made from patients on waivers, etc.  We can get the super-accurate data, but this is what we have on-hand today and it's pretty accurate, I suspect.  For example, how many Medicaid patients are on waivers?  Exactly.
  • Second, it's quite conceivable that I counted a state when I shouldn't have because I am not aware of all the differences among "Blue Cross" vs. "Blue Shield" that exist in different parts of the country.  Most often, the follow each other identically.  But in places like PA, you can't just trust that the word "Blue" in the name means "BCBS."  I did my best.


Thanks again to Igor, we know that the states where BCBS appears to cover 96110 include: AL, AZ, CA, CO, CT, DE, FL, GA, IL, KS, MA, MD, MI, NC, NH, NJ, NY, OH, OK, PA, RI, TN, TX, UT, VA, VT, WV, WY. 28 states - not bad, considering the relatively low usage of this code and the fact that we don't have any clients in places like Alaska, Hawaii, North Dakota, etc.  Sure, we have clients in Maine, but I think it's more likely that they aren't billing and not that it isn't being paid.

As for Medicaid, the list is similar, though not identical: AL, AR, AZ, CO, CT, GA, KS, MA, MI, NC, NH, NJ, NY, OH, OK, PA, TN, TX, VA, VT, WA, OR, WV, MT, WY.  25, I believe. That means at least 1/2 of them (and quite likely many more).


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