Provider Reimbursement

DELPHI CARD® physician reimbursement schedules are based on Medicare's current physician fee schedule. To determine the reimbursement for a specific CPT-4 Code, multiply the Medicare amount by the factor shown below for the corresponding code range.

  • CPT-4 Code range:
  • 10000-29999 & 50000-69999 paid at factor 2
  • 30000-49999 paid at factor 2.2
  • 70000-79999 paid at factor 1.9
  • 80000-89999 paid at factor 1.81
  • 90000-96999 & 99201-99245 paid at factor 1.2
  • 97000-97999 paid at factor 1.3
  • 98000-99195 paid at factor 1.25
  • 99251-99999 paid at factor 1.15

1Codes within the 80000-89999 range are multiplied by different percentages. The % for this code range is an average.

Only self-funded or partially self-funded clients access the above reimbursement schedules. Full insurance participants do not access this reimbursement schedule. Fully insured DELPHI CARD® clients, the Provider will be reimbursed by the carrier according to whichever network the participant has access, whether or not Provider is contracted to that network, plan deductibles, copays, and all other plan stipulations.