Q: This is my first year in practice. I just contracted with a health network. I will get pip cases from them and group health patients. Can I have two different fee schedules because auto injures pay out much better. Can I have a set fee for that and then a lesser fee for health plans where patients pay a deductible. I didn¼t see anything in the contract and I am not sure if this is acceptable. We have a separate fee schedule for workers comp in our state because they set the fees. Your advice is needed A: Thanks for the e-mail. It is my opinion that it is unacceptable to have two fees for different patient insurance companies unless you are contracted as such. Therefore WC which is state regulated sets fees and that's it. You didn't create the different fees this is what you will get no mater what you charge them .. the fee is set and therefore contracted as such. The same is true for managed care insurance programs. Usually when you sign a contract they send you the fee schedule .. a set fee they will pay per services minus the co-payments and other reductions they may or may no have. This is also state regulated because an insurance company must get permission from the insurance commissioner of each state to provide the insurance and someone must sign off on it. They may not care or even be interested in the fees that the company will pay the providers since it is usually the providers that must accept or not the fee and restriction arrangements by signing the contract. But it is a agreed fee schedule that allows you to charge your own office fee per service but be paid whatever the contracted fee is. In other words .. you set your office fee for each service as a one fee for everybody. What you receive may be different but your established fees are always the same. Now .. where you may receive more for your services .. between health and PI services .. you have to find out what services are covered. If you joined a managed care company for PI and health insurance you may be surprised that they will be restricting the number of visits and the fees they pay .. this is the nature of the program you joined as they attempt to contain costs. But .. it is my opinion that you establish a fee for each service and for the PI patient .. if they need it .. use and charge for the service. In my office our adjustment fee is $35 for a 98940 and $50 for a 98941. We also charge $20 for a spinalator type table code and $15 for moist heat along with this. I am in almost all the managed care programs and I know up front which pays for what. If some insurance company pays for therapy and I provide the service we charge for it .. we don't create a new fee just for them .. the fee has always been my established fee and since the service was provided we bill for it. If someone has an auto accident and used their Medpay auto insurance we charge our established fees for services rendered .. the payments to us will be larger since this insurance carrier pays the full fee not an negotiated fee. But we don't have two or three fee schedules for different insurance programs. We have one fee .. for each service and charge if rendered. I hope this was clear Have a Great Day Dr. M