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Naturopathic Physician (ND) Insurance Reimbursements Rates by Code in Washington State in 2008 PDF Print E-mail
Written by John Weeks   

Naturopathic Physician (ND) Insurance Reimbursements Rates by Code in Washington State in 2008

Summary: This article offers a chart of payment rates to naturopathic physicians by insurers in the state of Washington  in 2008. The chart is by code and by insurer for Regence (Blue Shield), Premera (Blue Cross), Uniform Medical, CIGNA, Aetna, Group Health, United Healthcare and Pacificare. Rates vary significantly. Washington has the most mature market for 3rd party inclusion of these practitioners in the insurance system following a 1995 law that required all plans to include "every category of (licensed) provider." While recognized in the state as primary care providers, individual plan recognition of their role varies. These data were gathered from various individuals in the state.
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Image
State law led to widespread coverage of NDs
Individuals from outside the state of Washington are typically astonished to learn that for 15 years insurers in this state, where I reside, have been required to include all licensed practitioners in their offerings. The inclusion began with the "every category of provider" statute re-affirmed by the legislature in 1995, and backed administratively and in the courts by the activist Insurance Commissioner Deborah Senn.

Those from the 34 states without licensing of naturopathic physicians (or "naturopathic doctors" as medical doctors have in some states restricted their self-appellation) are particularly surprised to learn that individuals in some plans can choose these practitioners as their primary care practitioners, responsible for managing all their care. (Examples are Regence Blue Shield and the state employees' Uniform Medical Plan.) Washington has a loan repayment program under which eligible NDs are able to have their education debt alleviated for service in underserved communities.

Behind all of this surprise is typically a question: But what are these NDs getting paid? Here, from data assembled in 2008, are reimbursement data, by code and by insurer. 

____________________________________

Payment Rates for Naturopathic Physicians
by Insurance Plan and by Code in Washington State in 2008


Source: Data shared by individuals in the state.









Healthways WholeHealth Network
OptumHealth Care Solutions
CPT Code Minutes Description Regence Regence
Premera
Uniform
CIGNA Aetna
GHC
United Pacificare  



1-Apr-08 1-Apr-09


1-Jul-08
2-Jan-05 1-Jan-09
1-Jan-09


 

















 

















 
99201 10 New; Focused


36.38
53.70
36.00 36.00
37.00
36.00
 
99202 20     Expanded 88.44 89.26
64.50
93.44
58.00 60.00
63.00
58.00
 
99203 30     Detailed 129.61 130.82
96.00
136.40
81.00 85.00
87.00
81.00
 
99204 45     Comprehensive 198.73 200.85
135.75
208.89
113.00 120.00
119.00
113.00
 
99205 60     Complex 250.57 252.91
171.75
263.67
148.00 150.00
150.00
148.00 >290.00  

















 
99211 5 Return; Focused 27.45 27.70
21.38
29.00
17.00

19.00


 
99212 10     Expanded 52.35 52.84
38.25
55.31
30.00 32.00
33.00
30.70
 
99213 15     Detailed 84.88 86.18
52.13
90.22
44.00 46.00
48.00
44.00
 
99214 25     Comprehensive 128.59 129.79
81.75
135.86
67.50 71.00
70.00
75.00
 
99215 40     Complex 174.33 175.96
118.88
183.65
99.00 106.00
103.00
99.60
 

















 
99241 15 Consultation; Focused


49.88
71.42
51.00 45.00
0.00
44.00
 
99242 30     Expanded 127.06 128.25
91.13
133.71
80.00 90.00
0.00
70.00
 
99243 40     Detailed 174.33 175.96
121.50
183.12
102.00 115.00
0.00
90.00
 
99244 60     Comprehensive 257.17 259.58
171.00
270.65
134.00

0.00
120.00
 
99245 80     Complex 317.66 320.63
221.25
334.01
176.00

0.00
155.00
 

















 
99354 30-74 Prolonged; 1st addt'l 1hr
130.11
81.74
126.51

90.43
0.00


 
99355 75-104 Prolonged; ea addt'l 30m









0.00


 

















 
99381
New Prev Infant


102.75
133.71
52.00 85.00




 
99382
     1-4


110.63
144.99

109.00




 
99383
     5-11


108.38
142.84

95.00




 
99384
     12-17


117.75
155.73

105.00




 
99385
     18-39 147.39 148.77
117.75
155.73

116.00




 
99386
     40-64 172.81 174.42
138.38
182.58

139.00




 
99387
     65+


150.00
199.23







 

















 
99391
Periodic Prev Infant 101.65 102.60


107.40
41.00 68.00




 
99392
     1-4 113.34 114.91


120.29

91.00




 
99393
     5-11 112.83 113.89


119.21

91.00




 
99394
     12-17 124.01 125.17


131.03

103.00




 
99395
     18-39 125.03 126.20


132.10

100.00




 
99396
     40-64 137.23 138.51


144.99

111.00




 
99397
     65+




161.64







 

















 
99401
Prevent. Couns 15 min


41.63
52.63







 
99402
    30 min


70.13
89.68







 
99403
    45 min


97.13
125.66







 
99404
    60 min


124.50
161.10







 

















 
97124
Massage 15min













 
97140
Manual Therapy 26.98

16.46
38.13

28.00


27.00
 
97810
Acup 15min













 
97811
Acup addtl 15min













 
97813
Acup w/Elec 15min













 
97814
Acup w/Elec addtl 15min












 
98925
Osteo Manip 1-2 regions 39.14

26.86
41.35







 
98926
     3-4 regions 54.39

34.15
57.46







 
98927
     5-6 regions 69.64

43.69
74.11







 
98928






86.46







 
98929

94.53



99.35







 

________________________________________

The variation in fees is significant, as it is for other practitioners. The top end is defined by the plans that are locally-based and most respect these practitioners as primary care (Regence and Uniform Medical Plan) with the low end defined by the Minnesota-based managed care giant, United Health. For direct-access primary care, a complex visit with United ($148) paid at just 56% the rate of the same type of visit with Uniform Medical Plan ($263.67). For complex consultations, the disparity is even worse: United, at $155, is just 45% of Uniform's rate of $341.

Image
Deborah Senn: Former Insurance Commissioner had key roles in ND coverage
The naturopathic payment scale is similar to that of a
medical doctor (MD) in plans like Regence, based on resource-based relative value units (RBRVUs). This reflects the reality that the burden of medical school education on a naturopathic doctor is significant. Debt loan is presently frequently between $100,000 and $200,000 for new doctors.

Comment: I have been sitting on these data for some time, thinking I would include them as part of a more significant piece on the Washington experience. After not getting around to that, I decided their publication would be useful to those seeking to understand this discipline. Notably, a health services research project published in 2010 (see Analysis of Washington Insurers data here) found that patients with significant disease burdens who saw covered CAM practitioners
(not just or only NDs) cost the insurance company $1420 less. (Interestingly, cost was $158 more for those with less burden.)

Those interested in knowing more about the state's experience with covering naturopathic doctors are served to search under William Lafferty, MD. Lafferty has now produced a series of articles funded under very useful NIH National Center for Complementary and Alternative Medicine health services research grants. Lafferty was a secondary author on the study noted above.

One brief point in reference to a statement on student loans at the top of the article: While Washington and, since 2010, Oregon each include naturopathic doctors among those who can participate in loan payback programs if they help meet primary care underserved or rural health needs, neither state funded their programs in 2010. Naturopathic doctors are not presently eligible for participation in the much more significant payback programs through the US Bureau of Primary Health Care.

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