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Pectus Brace Billing Information

How much will each visit cost?


The estimate of prices and traditional charges for professional service are listed below. These prices are only valid for services through 6/30/2020. Every child is different and treatment plans may vary. In addition to each office visit or consultation, your child may also be evaluated by a physical or occupational therapist. The pricing list below does not provide an inclusive list of all services your child may need during their services for Pectus Brace. If you have questions regarding pricing, please call Financial Clearance at (816) 302-1650, option 4.

Procedure Code  Description of Treatment   Standard Price*   
99201-99205 New Patient Office Visit  $95.00-$438.00
99211-99215 Established Patient Office Visit  $50.00-$307.00
99241-99245 Office Consultation $118.00-$554.00
97161-97163 PT Eval $299.00
97165-97167 OT Eval $312.00
97760 PT/OT Fit and Train $159.00 (per 15 minutes)

 

What happens after our consultation?


If your child has been identified as a pectus brace candidate, the clinical team will reach out to the Financial Clearance team to pursue a prior authorization and to determine if your insurance company will cover the brace.

How long should the prior authorization process take?


It can take up top 30 days to get the prior authorization approval. Once a determination has been made, a Financial Clearance Specialist will reach out to you. If you have not heard from a member of the Financial Clearance team 30-45 days after your consultation, please reach out to Financial Clearance at (816) 302-1650, option 4 for an update. Please note, if you have any concerns related to benefits or timeline concerns with your plan, please alert the clinic team and/or the Financial Clearance team immediately.

What can I do while waiting for the prior authorization process is taking place?


We recommend that you contact your health plan with the procedure code and price provided below to check your benefits and coverage for Pectus Brace. Your insurance will be able to inform you what your remaining out-of-pocket expense will be (including, but not limited to, deductibles, co-payments and co-insurance) prior to the service. Please also confirm Children's Mercy participates with your insurance plan and ensure that all necessary referrals are in place. You can visit our website at choosechildrensmercy.org for a listing of all contracted health plans that have chosen to participate with Children's Mercy. Additional frequently asked billing questions can also be found online through our Patient Financial Services.

How much does a Pectus Brace cost?


Listed below is the average price for the Pectus Brace. These prices are only an estimate as every patient is different and requires a unique treatment plan. If your insurance does not cover Pectus Brace, there may be a no insurance discounted price available. Price below is valid through 06/30/2020.

Procedure Code Description of Treatment Standard Price*
L1499 Pectus Brace $3,250.00


Financial assistance


The Pectus Brace is not eligible for the Children's Mercy financial assistance discount program.