Physician Office Visit Fees

Our participating physicians' fees for office visits are prominently displayed on the back of the Care Card so our Members will know exactly what they can expect to pay for services. In certain circumstances, a physician may charge less than these fees but in no event shall office visits fees exceed the following:

• A Level 1 Office Visit is a visit of brief duration: $35.00
• A Level 2 Office Visit is a visit of medium duration: $46.00
• A Level 3 Office Visit is a visit of moderate complexity: $63.00
• A Level 4 Office Visit is an extended or complicated visit: $95.00
   

Any other in-office procedure will be charged at 110% of the 2003 Georgia Medicare prospective rates (see below).
Care Card Fees for In-Office Procedures
Doctors Direct Care Card fees are listed for each separate CPT Code© (American Medical Association's medical definitions of services performed according to "Current Procedural Terminology") which relates to the services a participating physician may perform at the time of visit by a Care Card Member. The fees are listed in three (3) separate parts following the 2003 Georgia Medicare listing convention used at that time. The 3 parts are Professional Fees (which are fees for physicians' professional services) pages 1-84, Clinical Laboratory Fees (lab tests) pages 85-95 and J Code Fees (injections) pages 96-100.

These fees represent only 10% more than Medicare (the largest purchaser of medical services in the United States) paid in our area of Georgia during the calendar year 2003.
There are special circumstances where Medicare does not establish prospective fees for certain services for any number of reasons. Immunizations and some injections are examples. Those procedures, for which prospective fees have not been set by Medicare, will be priced by a participating physician at those net fees that he or she would otherwise accept from an insurance company after the billing and collections procedures have been exhausted. As always, Care Card fees are applicable when payment is made at the time of service.

For those fees Click Here