Choosing Wisely - More Tests Are Not Always Better

Choosing Wisely is a new campaign designed to help patients and physicians understand when certain tests need to be done and when they don’t. Nine different specialty societies (including the American Academy of Family Physicians) have been looking at evidence and providing resources published to the public through Consumer Reports. You can access these resources online here.

The campaign has published lists of specific tests for medical problems that are often ordered but frequently are not needed. For example, one of the most common reasons I see patients in my office is for back pain. While back pain can be extremely painful, most often acute back pain resolves on it’s own in 6 weeks. However, many patients end up getting imaging tests done such as X-rays or MRI’s during that first 6 weeks. In our American medical culture, we often have the perception that more information will help you get better faster. But, that is not always the case. In fact, imaging of the back in patients within the first 6 weeks of back pain does not improve the outcome for the patient and often leads them to have procedures done which likely they did not need. In fact, I see many patients who have even more back pain after surgery which likely did not need to be done in the first place. Thus, the AAFP has recommended in their Choosing Wisely list to avoid imaging for patients with back pain within the first 6 weeks of the onset of their pain.

I agree with this recommendation. The problem is that many patients do not. And in an effort to satisfy the patient, doctors end up ordering the tests anyway. Also, in our litigious society, doctors are afraid if they wait to order the tests and it turns out a patient does need a further procedure, they will be sued for delaying the diagnosis (despite the fact that studies show it does not affect patient outcomes.)

These lists are an effort to encourage patients and doctors to discuss when tests are actually needed. And, I encourage my patients to recognize that more tests are not always the answer for your discomfort. Ordering more tests is a large part of the reason that America has the highest cost of medical care and the most unhealthy patients.

Non-Covered Services (08/07/2023)	Innova Fee
Each page of medical paperwork, letters or forms for completion within 5 business days.	$10.00
Expedited processing for medical paperwork, letters or forms for completion within 2 business days.	$25.00
Each Clinical response to a patient portal inquiry outside of an appointment or Medicare e-visit.	$15.00
Results already provided on the portal, printed and mailed outside an appointment	$15.00

Non-Service Fees (8/8/2023)	Innova Fee
Patient late cancellation fee (less than 24 hours notice/10 minutes late for appointment)	$25.00
No-show fee for missing a routine appointment	$50.00
No-Show of an Annual Wellness Visit	$100.00

*Some of the most commonly provided services at Innova	Innova Fee	CPT Code
*Established Patient Office Visit Level 3	$111.00	99213
*Established Patient Office Visit Level 4	$157.00	99214
*Injection in deep muscle or subcutis	$29.00	96372
*Medical Service provided on holiday eve, holiday or weekend	$28.00	99051
*Chronic Care Management (Medicare program)	$61.00	99490
*Established Patient Preventive Care for Age 18 - 39 years old	$123.00	99395
*Established Patient Preventive Care for Age 40-64 years old	$134.00	99396
*In office Flu Swab	$17.00	87804
*Immunization injection administered	$29.00	90471
*Steroid (Injectable) Medication	$8.00	J0702
Treatment of used to clear a skin lesion of pus to start the healing process	$177.00	10060
Treatment of used to clear a skin lesion of pus to start the healing process	$306.00	10061
Procedure where a small round piece of tissue is sent to the lab for biopsy	$180.00	11104
Skin tag removal of 1 lesion	$128.00	11200
Skin tag removal of more than 1 lesion	$27.00	11201
Shave removal of skin lesion on midsection less than 0.5 cm	$145.00	11300
Shave removal of skin lesion on midsection 0.6 cm to 1.0 cm	$174.00	11301
Shave removal of skin lesion on midsection 1.0 to 1.2 cm	$197.00	11302
Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia	$153.00	11305
Shave removal of a single lesion, scalp, neck, hands, feet, genitalia	$175.00	11306
Shave removal of a single lesion, face, ears, eyelids, nose, lips less than 0.5 cm	$166.00	11310
Shave removal of a single lesion, face, ears, eyelids, nose, lips 0.6 cm to 1 cm	$196.00	11311
Shave removal of a single lesion, face, ears, eyelids, nose, lips 1.0 cm to 2.0 cm	$223.00	11312
Excision of benign (normal) lesion including margins 0.6 cm to 1 cm	$223.00	11401
Nailbed removal	$164.00	11730
Removal of Implanted Device	$191.00	11982
Wound or cut greater or equal to 2 cm	$134.00	12001
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet)	$162.00	12002
Other Repair (Closure) Procedures on the Integumentary System	$99.00	15851
Removal of first lesion	$96.00	17000
Removal of 2 to 14 skin lesions (1 additional unit for each)	$10.00	17003
Removal of 15 or more skin lesions	$238.00	17004
Removal of skin lesions	$485.00	17106
Removal of 1 to 14 skin lesions	$160.00	17110
Destruction (laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags	$187.00	17111
Chemical Cauterization of Skin	$127.00	17250
Cryo (freezing) treatment of skin	$76.00	17340
Small joint or bursa injection	$73.00	20600
Intermediate joint or bursa injection	$79.00	20605
Marge joint or bursa injection	$93.00	20610
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method	$398.00	30802
Incision Procedures on the Vulva, Perineum and Introitus	$215.00	56405
Nerve Block Injection	$109.00	64405
Removal of unspecified object from eye	$70.00	65205
Removal of unspecified object from ear	$114.00	69200
Removal of impacted ear wax	$21.00	69209
Ear Cleaning	$69.00	69210
Imaging Exam	$43.00	76000
Ultrasound of abdomen complete including kidneys	$114.00	76770
Ultrasound of tendon or a muscle	$59.00	76882
Urine Drug Screening	$12.00	80305
In office urinalysis	$3.00	81002
In office urine pregnancy test	$3.00	81025
In office blood sugar test	$3.00	82962
Skin injection to test for tuberculosis	$6.00	86580
In office blood test for Mono	$12.00	87449
COVID-19 infectious agent antigen detection by immunoassay (quick test)	$36.00	87426
COVID-19/Flu-A/Flu-B infectious agent antigen detection by immunoassay (quick test)	$39.00	87428
In office flu swab	$12.00	87804
In office Strep Swab	$12.00	87880
Pediatric injection administered (given)	$29.00	90460
Additional pediatric injection administered	$20.00	90461
Additional Immunization injections administered	$22.00	90472
Menactra Vaccine	$157.00	90619
Hepatitis A vaccine injection for pediatric and adolescent	$37.00	90633
Hepatitis A and B Vaccine Adult	$122.00	90636
HIB Vaccine	$13.00	90648
Gardasil or HPV vaccine for ages 9 to 26	$161.00	90649
Gardasil Vaccine	$288.00	90651
Flu Shot for patients 3 years old and older	$20.00	90656
Flu shot for pediatric patient age 6 months to 35 months old	$7.00	90657
High Dose Flu Vaccine for patients over 65 years old	$74.00	90662
Pneumonia Vaccine in vial	$227.00	90670
Pneumonia vaccine injection, 20 valent	$284.00	90677
Rotavirus vaccine	$96.00	90680
Fluzone Vaccine	$23.00	90686
Dtap vaccine for ages 6 and younger	$29.00	90700
MMR Vaccine Injection	$90.00	90707
IPV Vaccine Injection	$41.00	90713
Tetanus and Whooping Cough Vaccine Injection	$39.00	90715
Chickenpox Vaccine Injection	$175.00	90716
Pediarix Vaccine Injection	$91.00	90723
Pneumonia Vaccine Injection	$118.00	90732
Menactra Vaccine Injection	$142.00	90734
Hepatitis B Pediatric Dose or Adult Dose	$28.00	90744
Hepatitis B Vaccine for Adult Injection	$67.00	90746
Shingles Vaccine Injection	$184.00	90750
Diabetic retinal screening	$44.00	92250
Complete EKG	$17.00	93000
EKG recorded and reviewed	$229.00	93268
Ambulatory Blood Pressure Monitoring	$53.00	93784
Cerebrovascular Arterial Ultrasound	$319.00	93890
Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries	$98.00	93922
Complete bilateral noninvasive physiologic studies of extremity arteries, 3 or more levels	$152.00	93923
Noninvasive physiologic studies of lower extremity arteries	$188.00	93924
Evaluation of arterial inflow and venous outflow of abdomen and/or pelvic organs	$319.00	93975
Lower extremity ultrasound with doppler	$140.00	93979
In office test used to assess how well your lungs work to diagnosis asthma and COPD	$31.00	94010
Nebulizer treatment in office	$13.00	94640
Pulse Oxygen	$4.00	94760
Immunotherapy Injection	$13.00	95117
Immunotherapy Observation	$162.00	95180
Blood Glucose Monitoring	$162.00	95250
Blood Glucose Monitoring	$68.00	95249
Glucose monitor for continuous	$42.00	95251
Brief emotional or behavioral assessment	$8.00	96127
IV initial	$48.00	96360
IV add on	$19.00	96361
Injection	$28.00	96373
After hours call/consult after 10PM	$28.00	99050
Screening Vision Test	$4.00	99173
New Patient Office Visit Level 2	$97.00	99202
New Patient Office Visit Level 3	$151.00	99203
New Patient Office Visit Level 4	$225.00	99204
New patient office visit level 5	$297.00	99205
Established Patient Office Visit Level 1	$34.00	99211
Established Patient Office Visit Level 2	$69.00	99212
Established Patient Office Visit Level 5	$220.00	99215
New Patient Preventive Care for Age 1-4 years old	$158.00	99382
New Patient Preventive Care for Age 5-11 years old	$164.00	99383
New Patient Preventive Care for Age 12-17 years old	$186.00	99384
New Patient Preventive Care for Age 18 -39 years old	$180.00	99385
New Patient Preventive Care for Age 40 - 64 years old	$165.00	99386
Established Patient Preventive Care for less than 1 year old	$111.00	99391
Established Patient Preventive Care for Age 1-4 years old	$119.00	99392
Established Patient Preventive Care for Age 5-11 years old	$119.00	99393
Established Patient Preventive Care for Age 12-17 years old	$130.00	99394
Established Patient Preventive Care for Age 65 and over	$151.00	99397
Smoking and tobacco use counseling to the patient for 3-10 minutes	$21.00	99406
E-visit 5-10 minutes via portal	$15.00	99421
E-visit 11-20 minutes via portal	$30.00	99422
E-visit 21+ minutes via portal	$50.00	99423
CCM (Chronic Care Management) staff time additional 20 minutes	$64.00	99439
Provider Phone Evaluation	$98.00	99443
Providing care planning to individuals with cognitive impairment	$355.00	99483
First 60 minutes of non-face-to-face care by clinical staff for complex chonic care	$127.00	99487
Additional 30 minutes of non-face-to-face care by clinical staff for complex chronic care	$67.00	99489
Chronic Care (Medicare Program)	$65.00	99490
Chronic Care Management (Medicare program) Provider Call	$91.00	99491
Transition of Care Management Communication within 14 days of discharge	$274.00	99495
Transition of Care Management Communication within 7 days of discharge	$371.00	99496
Advanced Care Plan	$119.00	99497
Administration of Flu Vaccine	$29.00	G0008
Administration of Pneumonia Vaccine	$29.00	G0009
Administration of Hepatitis B Vaccine	$29.00	G0010
Diabetes self-management training services, group session (2 or more), per 30 minutes	$25.00	G0109
Physician service required to document the need for a power mobility device	$15.00	G0372
Initial Preventive Examination; face-to-face visit, new CMS patient during first 12mths	$231.00	G0402
EKG at the Welcome to Medicare Preventive Visit	$17.00	G0403
Annual Wellness Visit Initial Visit	$231.00	G0438
Annual Wellness Visit Visit	$180.00	G0439
Screening for alcohol misuse and brief behavioral counseling	$28.00	G0442
Screening for alcohol misuse and brief behavioral counseling	$42.00	G0443
Annual depression screening	$28.00	G0444
Personally performing CCM (Chronic Care Management) care planning	$64.00	G0506
Remote image submit by pt	$19.00	G2010
Brief check in by md/qhp	$23.00	G2012
Visit occuring in Primary Care setting	$17.00	G2211
Antibiotic medication injection	$1.00	J0696
Steroid (injectable) medication	$7.00	J0702
Osteoporosis treatment injection	$25.00	J0897
Steroid, anti-inflammatory (injectable) medication	$11.00	J1040
Testosterone medication injection	$1.00	J1071
Betamix Medication for injection	$1.00	J1100
Toradol medication injection- Nonsteroidal anti-inflammatory drug to treat pain	$1.00	J1885
Anti-nausea medication injection	$4.00	J2550
Vitamin B-12 Injection	$2.00	J3420
Saline solution for wound care cleaning	$3.00	J7030
CCM (Chronic Care Management) staff time additional 20 minutes	$47.00	99439
Diabetic Retinal Screening	$53.00	92250
Monoclonal Antibody Covid-19 Infusion	$403.00	M0243

Choosing Wisely – More Tests Are Not Always Better

Recent Posts