Here is a summary of R-CPD fees and charges for evaluation and treatment.
Note: All BVI charges are billed to insurance companies through Bastian Voice Institute’s National Provider Identifier (NPI) 1922122571
DISCLAIMER: The charges provided are an “accurate estimate” and are subject to change. Charges billed by MCDS are based on information provided to Bastian Voice Institute by MCDS; these charges should be verified with MCDS.
Questions for MCDS? Call 630.796.4998
Questions for BVI? Call 630.724.1100
Day One: Initial Evaluation at Bastian Voice Institute (BVI)
| Charge | Fee Description | Insurance Billing Code |
|---|---|---|
| $395.00 | Office Visit (BVI) | CPT 99204 |
| $567.00 | Videoendoscopic Swallow Study (BVI) | CPT 92612-GN |
| $100.00 | Review of Videoendoscopy | CPT 92613 |
| $1,062.00 | Total Day One Charges | (BVI offers a 15% discount if paid in full by patient [$850]) |
Day Two: Esophagoscopy + Botox Injection, a short outpatient procedure under general anesthesia at Midwest Center for Day Surgery (MCDS)
| Charge | Fee Description | Insurance Billing Code |
|---|---|---|
| $600.00 | Esophagoscopy (BVI) 2 | CPT 43192 (eligible for BVI 15% discount) |
| $675.00 | Botox (MCDS) | This is the cost of the Botox with no markup. You will be asked to pay this amount at the time of your procedure at MCDS. |
| $900.00 | Use of facility (MCDS) | Billed by MCDS3 |
| $724.00 | Anesthesiologist (MCDS) | Billed by Anesthesia Associates3 |
| $2,874.00 | Total Day Two Charges | ($2,271 to MCDS + $600 to BVI) |
One Week Later: Follow-up appointment with Physician Assistant either in-person or via telemedicine
| Charge | Fee Description | Insurance Billing Code |
|---|---|---|
| $220.00 | Post-op visit (BVI) | CPT 99213 (99213-95 if telemedicine) |
TOTAL COST
$1,062.00 Total Day One charges
$2,874.00 Total Day Two charges (estimated)
$220.00 Total One Week Later charges
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$4,156.00 Total Cost if Billed to Insurance4 (Botox is out of pocket to MCDS)
$903.00 Total Day One charges (with 15% discount if paid in full by patient)
$2,784.00 Total Day Two charges (with 15% discount on BVI charges if paid in full by patient)
$187.00 Total One Week Later (charges with 15% discount if paid in full by the patient)
——————————————————————
$3,874.00 Total Cost if paid in full on the date of service (Botox is out of pocket to MCDS)
BVI will submit a claim to your in-network insurance for Day 1 charges, Day 2 Esophagoscopy fee, and one-week post-op follow-up. The surgery center (MCDS) will submit their charges.
BVI offers a 15% discount on our charges to those who pay in full at the time of service and who do not submit to insurance. MCDS offers its own payment options for those without insurance coverage or who are out of network. These options plus questions you may have about your MCDS bill can be discussed with the MCDS billing manager at (630) 852-9300.
1 - Anthem BCBS disclaimer: Day 2 charges are not covered by Anthem BCBS policies since the procedures is considered not medically necessary. The charges for Day 2 will be considered self-pay for both for the surgeon fee and the facility/anesthesia fee. 2 - If your insurance company requires pre-authorization for this procedure we are NOT able to help you obtain that until you have officially become a patient and have been seen by us in our office. 3 - MCDS and Anesthesia Associates will charge a different, higher amount if you are using insurance. Please contact MCDS and your insurance company to determine your financial responsibility for these charges if you are using insurance. 4 - Since each insurance company differs in coverage, this procedure may be denied as experimental and/or investigational. We cannot guarantee that your procedure will be covered by your insurance plan but will appeal any denials that may occur.
The diagnosis codes used for billing are:
• R14.2 Eructation
• R14.0 Abdominal distension (gaseous)
• K22.4 Dyskinesia of esophagus
It is within your rights to contact your insurance company prior to your visit and ask if the procedure is considered experimental or investigational.