Patient Playbook - Guide 3 - Checklist

Questions to ask billing before your procedure

Print this page or copy the checklist into your notes. Ask every question, write down every answer, and confirm the all-in price in writing before service.

How to print: use your browser Print command. The checklist below is designed to fit on one to two pages.

The checklist

Code and setting

What CPT code was ordered, and what CPT code will be billed if nothing changes?
Is contrast, tomosynthesis, Doppler, or any add-on code expected? Which codes?
What is the exact setting: hospital outpatient department, ambulatory surgery center, independent imaging center, or physician office? Facility name and address?
Does your practice perform the same code in another setting? What is the price there?

Price layers

What is the all-in cash price for that CPT code in that setting?
Is the professional fee included, or will the radiologist, cardiologist, or endoscopist bill separately? Amount?
Is the facility fee included? Amount, or not applicable in this setting?
For endoscopy: is anesthesia or sedation included, likely, or billed separately? Which group bills it?
For endoscopy or biopsy: is pathology included, likely, or billed separately? Which lab or group bills it?
Are supplies, contrast material, or recovery charged separately?

Day-of-change

If the plan changes on the day, what new code will be billed? (Example: diagnostic colonoscopy 45378 becomes biopsy 45380.)
What will the all-in price be under the changed code?
Who will tell me about the change, and will the new charge be reflected in a revised written estimate?

Written confirmation

Can you send the price in writing with CPT code, setting, and inclusions listed?
How long is the quote valid, and who provided it (name, department, date)?
If I am uninsured or self-pay, will this written price be my Good Faith Estimate?
What number do I call if the final bill does not match the written price?

Write the answers here

Item	Answer
CPT code ordered / billed
Setting and facility
Professional fee
Facility fee
Anesthesia
Pathology
All-in price and validity date
Day-of-change code and price
Quoted by (name / date)

Red flags that mean ask again

A quote without a CPT code.
A facility-only quote presented as the total price.
"Anesthesia and pathology will be whatever they bill" with no group name or range for a procedure where they commonly apply.
No answer to the day-of-change question for a colonoscopy or EGD.
A verbal-only quote the facility will not put in writing.

After the service

Compare the bill line by line with your written price. Match each CPT code, setting, and layer. If an uninsured or self-pay bill exceeds the Good Faith Estimate by $400 or more for the same provider, see Guide 2 for the dispute window. For any mismatch, call the billing number you wrote down and reference the written quote by date and who provided it.

How to run the call, step by step

Before you dial, open the procedure page for your test on this site and note the CPT code, the code variants, and the Medicare anchor. For example, the colonoscopy page and the upper endoscopy page each list the day-of-change codes that most often surprise patients.
Start the call with setting and code, not with price. Confirm where the service will happen and which code will be billed if nothing changes. Price questions asked before those two facts are settled produce numbers for the wrong service.
Walk the price layers in order: professional, facility, anesthesia, pathology, supplies. Mark each one included, separate, or not applicable, and write the amount or the billing group beside it.
Ask the day-of-change question out loud, even if it feels hypothetical. For endoscopy it is the difference between the diagnostic code you scheduled and a biopsy code you did not.
Close by asking for the written version and the callback number. Read your table back to the person who quoted it. Errors are cheapest to fix while you are both looking at the same list.

A short worked example of the checklist doing its job

Suppose the ordering office gives you one CPT code and the facility offers the same code in two settings. Your checklist now has two columns to fill instead of one price to accept. In the hospital outpatient column the facility layer is an OPPS payment and the professional fee is separate; in the imaging center or office column the same code is usually one global or nonfacility amount. The Price Anchor Explorer shows that split with the verified Medicare anchors for your code, so you can see which layer is missing from any quote that looks unusually low.

Nothing in that comparison requires a made-up cash price. It requires the same code, the same layers, and both answers in writing. That is the whole method, and it is why this site publishes anchors and questions instead of ranges it cannot verify. See How Prices Work for the two payment systems behind the columns.

Frequently asked questions

How long does the billing call take?

One focused call with this checklist usually covers the code, the setting, each price layer, and the day-of-change rule. Write down who answered and the date. If a layer is unknown, ask for the group that bills it and call them too.

What is the single most important question?

Ask for the all-in price in writing for the exact CPT code in the exact setting, with professional, facility, anesthesia, and pathology listed. A written all-in price is the document every later billing conversation refers back to.

What if billing will not put the price in writing?

For uninsured or self-pay care, ask for a Good Faith Estimate, which is the written form federal rules provide. For insured care, ask patient financial services for the written quote process. A verbal-only price is not a confirmed price.

What do I do when the bill does not match?

Compare each line with your written answers: code, setting, and layer. Call the number you wrote down, reference the written quote by date and provider, and ask for the mismatch to be explained line by line.