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