This is a listing of the current prices and fees for medical services at Family Care, PA. These prices represent the highest cost you could possibly incur for these services at our office, regardless of your insurance coverage. Be sure to read the two sections at the bottom of the page for additional details for in-network patients and how to use the CPT Codes provided to check your benefits for the service.
To start, here are a few recommended FCPA blog posts to learn about health insurance pricing and billing:
- How are charges determined for primary care services?
- A detailed breakdown of E&M codes and how they might apply to a particular visit.
- How do I determine the benefits on my insurance plan?
- A brief explanation of the structure of an insurance plan and where to find certain information.
- How do I determine patient responsibility for a charge?
- The reasons you might owe money for a medical service, with insurance.
- Things to know before you sign up for health insurance
- A breakdown of types of health insurance plans and how you can obtain them.
There are several factors that go into the codes and charges you’ll have at our office, so I definitely recommend the first article, at least!
If you would like to know the cost of a service or procedure code that is not listed on this page, please contact our office.
Prices for Standard Primary Care Services
Any visit, appointment, or consultation that involves a standard medical examination and/or requires any medical decision making to assess, diagnose, and treat a medical condition or issue. While the prices are mostly based on time, the nature of your visit also factors into your costs. In general, these are the same codes used for both in-person and remote visits.
Keep in mind that the times listed are also not the amount of face-to-face time you see the provider, but the amount of time the provider takes to see you. You are not billed for time with our front desk, medical staff, in the waiting room, or waiting for your provider to enter the room. You may be billed for portal correspondence, phone visits, telehealth visits, and weekend/after hours contacts with your provider.
In 2022, Family Care developed a primary care pricing plan for uninsured patients called “Medicare for All.” The name is completely original, of course. While not the same as a real single-payer system, uninsured patients still have access to the same prices for all services that Medicare pays for their patients. Basically, instead of making our own uninsured fee schedule, we just copy Medicare’s rates and pass them along to everyone.
To verify, you can check the Medicare Fee Schedule Lookup Tool. Click Begin Search. Accept the terms. Click here for instructions.
To confirm the “Non-Facility Limiting Charge” for a particular service, enter these inputs:
- Year: 2023
- Type of Information: All
- HCPCS Criteria: Search CPT Codes individually, or as a full group.
- Modifier: All Modifiers
- MAC Option: Specific Locality, “1150200 NORTH CAROLINA”
Reference the numbers listed under the “Non-Facility Limiting Charge” for verification.
Medicare loves decimals, but we’ve rounded everything to make the math easier.
- We round the Medicare number UP to the nearest dollar.
- eg. If Medicare’s price is $94.80, you will pay $95 (+$.20).
- We donate $1 per uninsured visit to our featured charity of the year.
- eg. If you pay $95, we donate $1 (+$.80).
- For 2023, our featured charity is the Durham Parks Foundation!
| CPT Code | Description | 2023 Medicare Price |
| 99202 | New Patient, 15-29 Minutes | $76 |
| 99203 | New Patient, 30-44 Minutes | $118 |
| 99204 | New Patient, 45-59 Minutes | $175 |
| 99205 | New Patient, 60-75 Minutes | $232 |
99202-99205: The provider sees a New Patient for an office visit. The visit involves straightforward medical decision making and/or the provider spends # minutes of total time on the encounter on a single date.
| CPT Code | Description | 2023 Medicare Price |
| 99212 | Established Patient, 10-19 Minutes | $60 |
| 99213 | Established Patient, 20-29 Minutes | $95 |
| 99214 | Established Patient, 30-39 Minutes | $135 |
| 99215 | Established Patient, 40-54 Minutes | $189 |
99212-99215: The provider sees an Established Patient for an office visit. The visit involves a straightforward level of medical decision making and/or the provider spends # minutes of total time on the encounter on a single date.
Prices for Preventive Primary Care Services
Periodic comprehensive preventive medicine reevaluation and management, including age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions; and the ordering of appropriate immunization(s), laboratory/diagnostic procedures. This visit is considered a preventive wellness exam and does not cover the discussion of problems, conditions, illnesses, or any other care that would be considered part of a “Regular Visit.”
| CPT Code | Description | 2023 Medicare Price |
| 99391 | Established Patient, AWV, Infant | $137 (-$12 for Kids) = $125 |
| 99392 | Established Patient, AWV, 1-4 Years Old | $137 (-$12 for Kids) = $125 |
| 99393 | Established Patient, AWV, 5-11 Years Old | $137 (-$12 for Kids) = $125 |
| 99394 | Established Patient, AWV, 12-17 Years Old | $137 (-$12 for Kids) = $125 |
| 99395 | Established Patient, AWV, 18-39 Years Old | $137 |
| 99396 | Established Patient, AWV, 40-64 Years Old | $137 |
99391-99396: HCPCS code G0438 for Annual Wellness Visit; includes a personalized prevention plan of service (PPPS).
In-Network Patients:
If you have insurance coverage through one of our “In-Network” insurers, you will likely incur lower costs for these services. If you just have a copayment for primary care visits, for example, that copayment amount is likely to be the most you would pay for your visit. If you have a procedure, surgery, or some extra service performed, your plan benefits may change, so be sure to ask your insurer if you have any questions about a particular service.
If you are unsure what your plan details include, check out our blog post on determining the details of your insurance plan for help.
CPT Codes:
The CPT Codes for the individual procedures are listed so our patients can determine their coverage and benefits for that service. If you are unsure how your insurance plan would cover a certain item, you can call the customer service number on your card to ask about your individual benefits for that particular CPT code. This will be the code our office submits for the service, so your insurer should be able to give you some idea about how your coverage would process that code before you actually receive the service and incur the expense.