Dear Dr. Joel: Good Morning and I hope you are doing well. I have a question and hope you can help me with the answer. I was told the other day by another DC that Medicare fees should be the lowest set fee in the office. In other words if my charges for spinal adjustment (989240) is 30 dollars for Medicare patients I cannot charge children 20 dollars for the same service(98940). I just wonder if that statement is true and if so what can a person do for wanting to help families with more than 2 children. Any input is appreciated. Thank you in advance. A: Every DC decides the protocols of their office procedures. Obviously this is within the realm of ethics and responsibility to your community and profession. Therefore .. only guidelines can be offered to us and we blend our way of practice within this parameter. In english this simply means you do what you feel comfortable doing. I never heard of having fees based on medicare .. and I've been in practice for 22 years and have a pulse on what is going on. Remember .. in this world of managed care and HMO's they often do dictate a fee base to thier providers and their usual and customary guidelines may be dictated on Medicare guidleline .. this is on an insurance by insurance basis and some state WC fee guidelines may have such parameters. Your friend heard what he heard and he know tells you and this is how it starts. Medicare fees are based on zip code and they are the fees set up for us whether we like it or not. We are not dictetd by theor rulings outside the Medicare enviorment In terms of charging fees for adults and children differently and forming a family plan .. do what you feel is both fair to you and them. The typical mistake made by new DC's is not placing a value on their care.For instance .. care is often given away with little respect to the doctors financial needs and debts being repaid. The conscious effort is to give away services in the hope of getting multitudes of new patients from our generosity. This often is never the case. If you set a $30 fee for a patient and offer a family discount as a standard office procedure this is your policy. $30 for the first family member .. possibly 25% less for the second family member and for a family of 4 or 5 charge a global fee of $50 a visit. Be creative this may be high for you .. but if you explain the benefits to the patients they may understand and be willing to pay. Discounted family fees are only fair if they all come the same day. Be aware thsat many DC¼s feel that there should be no reduced fee for any patient. Check my webpage under Practice Tips there is an article concerning this Have a Great Day Dr. M