What is the difference between Charge Amount and Expected Rate?

The charge amount is the amount you are charging to the insurance company. Usually, because of contracted rates, the amount you charge an insurance company is not what you expect to be reimbursed for. The charge amount should be consistent across all payers. The expected rate is the amount that you expect to receive as reimbursement. For more information about expected rates, please see: Expected Rates.

For example, we will use 97161 as the CPT code that we are billing. Let's say we are contracted with Blue Cross Blue Shield (BCBS) and Aetna. For 97161, Blue Cross Blue Shield pays $100.00 and Aetna pays $115.00. These amounts should be entered as Expected Rates. Your Charge Amount should be set to an amount higher than $115 since that is the highest amount we expect to receive.