MRI of the lower back

What the hospital lists

• MRI Lumbar Spine WO Cont

  Outpatient · hospital charge

  $1,965.60

Location and source

What the hospital lists

• Mri lumbar spine w/o dye

  Inpatient or outpatient · billing class not stated

  Note from the file: Reimbursed at the lesser of Medicare allowed amount or hospital's billed charges, minus any patient portion. Medical Supply - DME: lesser of 60% of ChoiceCare's 005-270 fee schedule or charges, less patient portion for covered items listed in the fee schedule; 50% of charges, minus patient portion, for items not in the fee schedule. Reimbursement rate may be 65% of ChoiceCare's 005-270 fee schedule for HomeHealth Routine DME. Physician claims (lesser of rates below or billed charges, minus patient portion): radiology - 85% for midlevels or 87% for providers of ChoiceCare's 201-581 fee schedule, oncology drugs - 85% for midlevels or 100% for providers of ChoiceCare's 201-580 fee schedule, all other services - 85% for midlevels, 100% for providers of ChoiceCare's 005-731 fee schedule Notes: Payer uses Medicare APC allowed amounts for reimbursement of OP encounters instead of the individual code amount. Some services may utilize an adjusted Medicare allowed amount for Oklahoma City, OK in this calculation. Please reach out to the payer or our billing office for an accurate estimate. Not all services are utilized/offered at all locations within a year but may still have a set standard charge in the charge master. Additionally, not all payers pay at the line item level, meaning an allowed amount cannot be determined per line item. This service was either not rendered or not paid at the line item within the last year by this payer.

  $2,994.75

The file doesn’t say whether this covers the hospital’s charge only. Confirm what it includes.

Location and source