Can you charge the patient the fee difference of a downgrade of D2740?

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Can you charge the patient the fee difference of a downgrade of D2740?

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If you are in network and the insurance downgrades the code can we collect from the patient?

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Asked on January 28, 2025
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It depends on your contract with the insurance company. If the EOB states you can charge the difference, then you can. If it does not, then you cannot. Most insurances will let you charge the difference of the MAC of the submitted charge and the payment of the downgraded code. But if you are in network, you have to charge what the EOB shows.

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Answered on January 29, 2025
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