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SRA, D.O., LLC

Services & Fee Schedule

This is for services provided by Dr. Spencer Augustin at 3201 C Street, Suite 606, Anchorage, Alaska 99503

SRA, D.O., LLC is currently in network with:

  • Blue Cross Blue Shield/Premera

  • MODA

  • Optum

We accept and are able to bill all other private insurance companies but please check with your plan to learn about coverage.

We are not set up or able to take Medicare, Medicaid or Denali Kid Care

Evaluation and Management Services: 99215 (Follow-Up Appointment)

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. This time includes chart review, face-to-face time and documentation. 

$510.00

                                                                     

 

​Evaluation and Management Services: 99214 (Follow-Up Appointment)

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. This time includes chart review, face-to-face time and documentation. 

$360.00

Evaluation and Management Services: 99213 (Follow-Up Appointment)

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. This time includes chart review, face-to-face time and documentation. 

$240.00

Evaluation and Management Services: 99417

Prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes. This time includes chart review, face-to-face time and documentation.

$100.00

Evaluation and Management Services: 99205 (Intake Assessment)

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. This time includes chart review, face-to-face time and documentation.

$575.00

Evaluation and Management Services: 99204 (Intake Assessment)

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter. This time includes chart review, face-to-face time and documentation.

$450.00

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​Medicine Services and Procedures: 90833

Psychotherapy, 30 minutes with patient when performed with an evaluation and management service. In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the same session. The treatment session with the patient typically lasts anywhere between 16 to 37 minutes.

$200.00

You will be provided with an estimate of the anticipated charges for your nonemergency care upon request. Please do not hesitate to ask for information. 

Hardship pricing is available based on individual situations, please inquire with your provider to see if you are eligible.

The undiscounted price may be higher or lower than the amount an individual actually pays for the health care services described in the list. 

 

Prices are subject to change without notice. 

CPT® Copyright 2020. American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. The CPT codes are provided "as is" without warranty of any kind. The AMA specifically disclaims all liability for use or accuracy of any CPT codes.

For more information on the Health Care Price Transparency Act please visit the DHSS website at http://dhss.alaska.gov/
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