I hope you meant that your carrier disallowed more than you expected,
rather than denying your claim for being above URC (usual reasonable
and customary). Most carriers alter their payment rather than denying
a claim outright because it is above the reasonable charge for other
physicians in the area.
If you check on the explanation of benefits sent by your insurance
company, there should be a 5 or 6-digit code which is the CPT code.
If it was an uncomplicated office procedure, it is probably coded
After obtaining the correct CPT code, I entered "CPT
codes+Idaho+pricing" on Google's search engine.
Once there, I found the CIGNA Healthcare Medicare Fee Schedule. I
downloaded the file "2003 Physician Fee Schedules" and looked up the
code "46803" from this 56-page fee schedule document.
For participating providers in the Medicare program, the UCR is
For non-participating providers, the UCR is $181.04.
Limiting charge for this procedure is $208.20.
If you have a different 5-digit code on your explanation of benefits,
I'll be glad to look that one up for you or you can download the file
and confirm the codes yourself. Please let me know if I can be of