Rates and Fees Disclosures
Rev. 08/01/2024
Notes:
Mid-2024 Changes: Please note we updated our rates effective 08/12/2024 to conform with mid-year Medicare reimbursement rate changes. Our per unit initial rates decreased slightly from January 2024 for therapeutic procedure codes; there was a slight increase for assessment codes and multiple unit and procedure rates over January’s rates. Cash discount increased slightly. Senior discount now in effect for persons over 70 years of age. Veteran on/off referral rates changed accordingly with base rate changes.
Fees are fully payable and due at time of service. Payments accepted in cash, credit/debit card, Cash App Pay, Google Pay, or Apple Pay. We also accept payments from Health Savings Account (HSA) and Flexible Spending Account (FSA) cards. Account programs govern use of these cards. Patient remains responsible for declined HSA/FSA payments.
No-contact payment or partial payments for services can made at time of scheduling by credit/debit card in our online scheduler through Square (same as in-office processing). Some services require prepayment or partial payment at the time of scheduling. We may be able to file medical claims on your behalf for our services with your health insurance company. Please ask us about this for more information or visit the Insurance pages on our website by choosing the Patients tab above, hover over the Insurance selection, and choose the appropriate option for you.
Cancellation and No-Show Fees:
Patients may cancel their appointment free of charge up to four hours prior to their appointment time with the exception of Urgent Care After Hours. Cancel via our online scheduler, by sending an email or using the contact form on our website, or by calling (603) 622-1112 anytime. The time stamp of the call or message determines whether a cancellation fee applies.
A cancellation becomes “late” when the patient cancels within four hours of their scheduled appointment time. We assess fees for late cancellations based on the length of the visit, whether the patient reschedules at the time of cancellation, and if we can fill the vacated time. The scheduler does not allow patients to late cancel online. Please call (603) 622-1112, send an email to admin@mbmyoskeletal.com, or use the contact form on the Contact Us page.
Late-canceling without rescheduling results in an higher fee as indicated in the table below. Patients may pay the cancellation fee before or at the time of their next appointment. Access to our scheduler remains available to those who late cancel whether they reschedule or not.
We charge No-Shows the full rate for business lost and not allowing us to fill the appointment time with another person who requires a visit. No-Show patients lose access to the online scheduler until they pay the missed appointment fee. Pay the fee in person at our office when we’re available or call (603) 622-1112 during working hours with your credit card details. Please do not leave credit card details in a voicemail message! We will not automatically charge a cancellation fee to a credit card on file.
| Type of Cancellation | Visit Length (mins) | Fee |
|---|---|---|
| Late Cancel w/Reschedule | 30/45/60 | $35.00 |
| Late Cancel w/Reschedule | 75/90/120 | $50.00 |
| Late Cancel w/o Resched | 30/45/60 | $50.00 |
| Late Cancel w/o Resched | 75/90/120 | $75.00 |
| No Show | 30 | $50.00 |
| No Show | 45 | $63.00 |
| No Show | 60 | $83.00 |
| No Show | 75 | $99.00 |
| No Show | 90 | $119.00 |
| No Show | 120 | $150.00 |
| Late Cancel | New Assessment | $50.00 |
| No Show | New Assessment | $125.00 |
MBM Rate Disclosures:
Evaluation Fees – In Network and Self-Pay
The following table displays the maximum charge for each new and established in-office in-network and cash patient assessment service. We may only charge one of these services on any given visit. Discount (not displayed) applied for cash visit.
| Procedure Code | Procedure | Max MBM Rate | CMS Rate |
|---|---|---|---|
| 97161 | New Pt Assessment Low Complexity 15-25 mins | $62.72 | $101.68 |
| 97162 | New Pt Assessment Low-Mod Complexity 26-35 mins | $74.46 | $101.68 |
| 97163-1 | New Pt Assessment Mod Complexity 36-50 mins | $87.79 | $101.68 |
| 97163-2 | New Pt Assessment Mod-High Complexity 51-60 mins | $117.68 | $101.68 |
| 97163-3 | New Pt Assessment High Complexity 61-75 mins | $145.07 | $101.68 |
| 97164-1 | Estab Pt Assessment Low Complexity 5-9 mins | $17.16 | $70.71 |
| 97164-2 | Estab Pt Assessment Low-Mod Complexity 10-19 mins | $42.07 | $70.71 |
| 97164-3 | Estab Pt Assessment Mod Complexity 20-29 mins | $68.20 | $70.71 |
| 97164-4 | Estab Pt Assessment Mod-High Complexity 30-39 mins | $96.70 | $70.71 |
| 97164-5 | Estab Pt Assessment High Complexity 40-54 mins | $134.87 | $70.71 |
See our Physician Consult Rates table at the bottom of this page for patients referred to us for consult and assessment only and not for treatment. After the visit, we will send the patient’s assessment to the referring physician.
In Office Therapeutic Procedure Fees – In Network and Self-Pay
The following table displays the maximum charge for one 15-minute procedure unit on a single date of service for In-Network insurance and cash patients. Discounts (not displayed) apply for cash visits, for performing or conducting more than one unit of any procedure (i.e., 30 minutes of procedure 97124 = 2 units), and for performing more than one procedure (bundling) during a visit (i.e., 3 units of 97124 and 1 unit of 97110). “Max MBM Rate” is our maximum rate for each procedure unit. “CMS Rate” is the current Medicare rate for our area for comparison. Tables reflect 2024 rates.
| Code | Procedure | Max MBM Rate | CMS Rate |
|---|---|---|---|
| 97110 | MAT Corrective Exercise | $29.73 | $29.73 |
| 97112 | Neuromuscular Retraining | $34.15 | $34.15 |
| 97124 | Massage Therapy | $30.88 | $30.38 |
| 97140 | Myoskeletal Therapy | $31.45 | $27.35 |
| 97530 | MAT Corrective Activity | $37.32 | $37.32 |
In Office Evaluation and Therapeutic Procedure Fees – Out of Network
The following table displays the maximum charge for single unit procedures and services on a single date of service for out-of-network insurance. Again, “Max MBM Rate” is our maximum rate for each procedure. “NFLC” are the current CMS Non-Facility Limiting Charges for each procedure for the State of New Hampshire for comparison. The CMS Non-Facility Limiting Charges are computed at higher amounts than their Facility rates. CMS allows non-participating providers (not authorized to bill Medicare or Medicaid) to bill higher percentage rates (non-facility limiting rates) because the insurance company reimburses the patient who, in turn, is responsible for paying the provider.
| PROCEDURE CODE | PROCEDURE/SERVICE | Max MBM Rate | NFLC |
|---|---|---|---|
| 97161 | New Pt Assessment | $67.40 | $109.27 |
| 97162 | New Pt Assessment | $80.02 | $109.27 |
| 97163-1 | New Pt Assessment | $94.34 | $109.27 |
| 97163-2 | New Pt Assessment | $126.47 | $109.27 |
| 97163-3 | New Pt Assessment | $155.90 | $109.27 |
| 97164-1 | Estab Pt Assessment | $18.44 | $75.99 |
| 97164-2 | Estab Pt Assessment | $45.21 | $75.99 |
| 97164-3 | Estab Pt Assessment | $73.29 | $75.99 |
| 97164-4 | Estab Pt Assessment | $103.92 | $75.99 |
| 97164-5 | Estab Pt Assessment | $144.94 | $75.99 |
| 97110 | MAT Corrective Exercise | $32.48 | $32.48 |
| 97112 | Neuromuscular Retraining | $37.31 | $37.31 |
| 97124 | Remedial Massage | $33.74 | $33.74 |
| 97140 | Myoskeletal Therapy | $29.88 | $29.88 |
| 97530 | MAT Corrective Activity | $40.77 | $40.77 |
Telehealth Rates
| Procedure Code | Procedure | Max MBM Rate |
|---|---|---|
| 97161 | Video Zoom New Patient Assessment | $62.72 |
| 97164-2 | Video Zoom Current Patient Assessment/Reassessment | $42.07 |
| 97110 | 15-Min Video Zoom MAT Corrective Exercise | $29.73 |
| 97112 | 15-Min Video Zoom MAT Neuromuscular Retraining | $34.15 |
| 97110 | 30-Min Video Zoom MAT Corrective Exercise | $52.24 |
| 97112 | 30-Min Video Zoom MAT Neuromuscular Retraining | $59.69 |
Physician Consult Rates
The following table shows our maximum charges for physician-referred consultations/assessments. A summary is a brief written report highlighting our findings in a few paragraphs without significant explanation. Our full report details the entire assessment over several pages. CMS and many insurance companies no longer pay these codes but rather use the New Patient Evaluation codes above. We continue to use these codes as described to differentiate fees for our own patients and those who are referred for assessment only.
| Procedure | Visit Length | MBM Rate w/Summary | MBM Rate w/Full Report |
|---|---|---|---|
| 99241 | Up to 15 mins | $41.39 | $67.09 |
| 99242 | 16-30 mins | $67.09 | $114.19 |
| 99243 | 31-40 mins | $95.13 | $165.38 |
| 99244 | 41-60 mins | $132.68 | $215.25 |
| 99245 | 61-80 mins | $179.50 | $267.75 |
Miscellaneous Charges
| Service | Time | Fee |
|---|---|---|
| MAT Urgent Care After Hours | Up to 60 mins | $115 |
| MAT UC After Hrs Cancelled due to referral | $35 | |
| Telephone Consult | 5-15 mins | No charge |
| In-Office Consultation | 30 mins | $30 |
| Zoom Consultation | 20 mins | $25 |
| Late Arrival Wait Charge | 5-10 mins | $15 |
| Late Arrival Wait Charge | 11-20 mins | $25 |
| Late Arrival Wait Charge | 21-30 mins | $40 |
| Records Review/Imaging | 5-9 mins | $15 |
| Records Review/Imaging | 10-19 mins | $25 |
| Records Review/Imaging | 20-29 mins | $45 |
| Consult/Training for MAT Practitioners | 30 mins | $40 |
| Consult/Training for MAT Practitioners | 45 mins | $60 |
| Consult/Training for MAT Practitioners | 60 mins | $80 |
| Consult/Training for MAT Practitioners | 90 mins | $120 |