*Typical billing questions/issues addressed below. If you have any further questions, please don’t hesitate to reach out via phone 919-942-4424 or portal message the office.
Please Note: Every New Year the Self Pay Fee Schedule of the office is updated due to our Self Pay Rates following the Medicare Fee Schedule that is updated yearly. Please keep this in mind if you are a self-pay patient or are used to a certain self-pay rate due to frequent non-covered charges.
Network Status and Benefits
Please know it is patient responsibility to ensure network status and benefits directly with insurance. Anything we relay is not with a 100% guarantee. Although we try to provide a courtesy when we notice things such as out-of-network status, patients are ultimately responsible for confirming this information with insurance before services are rendered.
When checking with insurance, please see the providers NPIs below:
Dr. Kahn 1013088350
Dr. Finkel 1114098530
Dr. Pajeau 1336133297
Ms. Rothman 1528507704
Ms. Barham 1396113296
*TIP - When an insurance representative is being unhelpful, they will say to check with the providers office, that is not an acceptable answer. The insurance plan is able and responsible for confirming benefits with a customer, they are the only ones that can guarantee such information for your specific benefit plan.
Discussion Time of Visits
For New Patient appointments and Follow Up visits, we bill based on discussion time of appointments. Keep in mind New Patient appointments typically run anywhere from 1-2 hours, where some circumstances are less or more. Knowing your benefits is your patient responsibility and you should anticipate general billing based on this information.
Phreesia Charge (Code 96136)
Since Carolina Headache Institute became a Private Practice, we implemented a check-in questionnaire that is deemed a requirement by the Partners of the Practice. The questionnaire includes things such as headache days data, sleep worthiness, phq-9, etc. Per the Partners these reports are necessary for every appointment and since these reports justify the ability to bill 96136 (Phreesia), that is why it is on your claim(s). Since we bill visits based on discussion time of appointments, the questionnaire saves the provider/patient the time it would take to collect this data during a visit and allows more time for patients to discuss their care. These reports are also extremely useful and beneficial to have in case of prior authorizations for medications/outbound referrals/testing/etc. The way in which 96136 is processed by every insurance is different, but in most cases, it is a covered code. If the code is non-covered and insurance deems the code is not billable to the patient, the code will be adjusted, otherwise self-pay rate would be applied. If you have further questions pertaining to the usefulness of the report, please speak directly to your provider.
Nerve Blocks
When nerve blocks are performed, depending on the location(s) of the injection(s), typically up to 3 nerve block codes can be billed.
Codes: 64450, 64405, 64400
Nerve blocks are typically non-covered by insurance. Sometimes all 3 codes, 2/3, 1/3.
It is patient responsibility to know your benefits before services are rendered.
The high estimate, if all 3 codes were denied and a Self Pay Rate were applied is: $249.24 (following current 2024 Fee Schedule rates)
VACCN
We are “out of network participating” with the VA. What this essentially means is that typically so long as authorization is in place, visits are covered at 100%. Due to our “out of network participating” status our office is unable to request new authorization when current authorization expires for appointments. It is patient responsibility to contact their in-network PCP or referring office to have them request new authorization when one is needed. *Our office only has the capability to request/ensure valid authorization for procedures such as botox.
Medicaid
Please Note: Every New Year the Self Pay Fee Schedule of the office is updated due to our Self Pay Rates following the Medicare Fee Schedule that is updated yearly. Please keep this in mind if you are a self-pay patient or are used to a certain self-pay rate due to frequent non-covered charges.
Network Status and Benefits
Please know it is patient responsibility to ensure network status and benefits directly with insurance. Anything we relay is not with a 100% guarantee. Although we try to provide a courtesy when we notice things such as out-of-network status, patients are ultimately responsible for confirming this information with insurance before services are rendered.
When checking with insurance, please see the providers NPIs below:
Dr. Kahn 1013088350
Dr. Finkel 1114098530
Dr. Pajeau 1336133297
Ms. Rothman 1528507704
Ms. Barham 1396113296
*TIP - When an insurance representative is being unhelpful, they will say to check with the providers office, that is not an acceptable answer. The insurance plan is able and responsible for confirming benefits with a customer, they are the only ones that can guarantee such information for your specific benefit plan.
Discussion Time of Visits
For New Patient appointments and Follow Up visits, we bill based on discussion time of appointments. Keep in mind New Patient appointments typically run anywhere from 1-2 hours, where some circumstances are less or more. Knowing your benefits is your patient responsibility and you should anticipate general billing based on this information.
Phreesia Charge (Code 96136)
Since Carolina Headache Institute became a Private Practice, we implemented a check-in questionnaire that is deemed a requirement by the Partners of the Practice. The questionnaire includes things such as headache days data, sleep worthiness, phq-9, etc. Per the Partners these reports are necessary for every appointment and since these reports justify the ability to bill 96136 (Phreesia), that is why it is on your claim(s). Since we bill visits based on discussion time of appointments, the questionnaire saves the provider/patient the time it would take to collect this data during a visit and allows more time for patients to discuss their care. These reports are also extremely useful and beneficial to have in case of prior authorizations for medications/outbound referrals/testing/etc. The way in which 96136 is processed by every insurance is different, but in most cases, it is a covered code. If the code is non-covered and insurance deems the code is not billable to the patient, the code will be adjusted, otherwise self-pay rate would be applied. If you have further questions pertaining to the usefulness of the report, please speak directly to your provider.
Nerve Blocks
When nerve blocks are performed, depending on the location(s) of the injection(s), typically up to 3 nerve block codes can be billed.
Codes: 64450, 64405, 64400
Nerve blocks are typically non-covered by insurance. Sometimes all 3 codes, 2/3, 1/3.
It is patient responsibility to know your benefits before services are rendered.
The high estimate, if all 3 codes were denied and a Self Pay Rate were applied is: $249.24 (following current 2024 Fee Schedule rates)
VACCN
We are “out of network participating” with the VA. What this essentially means is that typically so long as authorization is in place, visits are covered at 100%. Due to our “out of network participating” status our office is unable to request new authorization when current authorization expires for appointments. It is patient responsibility to contact their in-network PCP or referring office to have them request new authorization when one is needed. *Our office only has the capability to request/ensure valid authorization for procedures such as botox.
Medicaid
- We are only in-network with NC Medicaid, no out of state Medicaid plans nor family planning.
- Carolina Headache Institute was informed 07/10/24 that any patients with Medicaid-Direct that did not opt-in to a Medicaid Managed Care Plan would be auto-enrolled in a Medicaid Tailored Plan, with an effective date of 07/01/24. Our recommendation is to call Medicaid if you are not aware of this update.
- Medicaid Tailored Plans – we are out-of-network with all Tailored Plans.
- Medicaid Manage Care Plans – we are only in-network with Healthy Blue and Wellcare.