Price Comparison Tool
For purposes of complying with federal PCT requirements, MEHP is providing the 500 shoppable items and services as if rendered in the U.S. Only those shoppable items and services that can be provided on an urgent and emergency care basis shall have a cost component. Those shoppable items and services that do not have an urgent or emergency care basis in the U.S. will reflect the status of not being covered in the PCT. In addition to utilizing the PCT to obtain price comparison information, a member can also contact our Member Services team at (619) 365-4346, or via e-mail at memberservices@mediexcel.com, for the requested information.
Service Description | Plain Language Description | Service CPT Code | Notes |
|---|---|---|---|
Office/Outpatient Visit New | New patient office of other outpatient visit, typically 45 min | 99204 | See Note C2 below |
Office/Outpatient Visit New | New patient office of other outpatient visit, typically 60 min | 99205 | See Note C2 below |
Office/Outpatient Visit Est | Outpatient visit of established patient not requiring a physician | 99211 | See Note C2 below |
Office/Outpatient Visit Est | Outpatient visit of established patient requiring a physician | 99212 | See Note C2 below |
Office/Outpatient Visit Est | Established patient office or other outpatient visit, typically 15 minutes | 99213 | See Note C2 below |
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NOTE C1 - If this item/service is not separate from the primary reason for the emergency, then it would be considered an emergency care event in the U.S. and normally covered by MediExcel Health Plan. The percent refers to coinsurance of the allowed amount for the entire episode of care. The dollar amount is a copay per day.
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NOTE C2 - This item/service is not likely considered emergency care and would likely not be covered if rendered at a hospital emergency department. However, the service may be covered if provided at an urgent care facility or a provider providing urgently needed services in the U.S.
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NOTE C3 - This item/service will be covered if there is an underlying emergency care service, otherwise it will not be covered.
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NOTE NC1 - This item/service is not considered urgent care or emergency care and would not normally be covered in the U.S. by MediExcel Health Plan.
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NOTE NC2 - This item/service is considered preventive care and is not covered by MediExcel Health Plan in the U.S. under an urgent or emergency care basis.