American Society of Dermatology
2721 Capital Ave.
Sacramento, CA 95816-6004
Phone: (916) 446-5054
Message: (561) 873-8335
Fax: (916) 446-0500 		American Society of Dermatology, Inc.
A Voice for Private Dermatologists Since 1992

SPECIFY THE SERVICES YOU WILL AND WILL NOT PROVIDE

Your contract should detail all of the specific CPT/ICD-9 codes that will be included under capitation. 8 A separate list of codes that reflects higher-cost treatments, such as Mohs surgery, should be organized into the following four categories and negotiated separately at fee-for-service rates:

  • Hospital
  • Laboratory/pathology
  • PUVA
  • Large surgeries

Also clearly define and specify in your contract:

  • When your services will be available
  • Where they will be provided
  • Coverage provisions for after-hours or time off
  • Your responsibilities for hospitalized patients
  • Whether cosmetic services are provided for under the plan, which procedures are considered cosmetic, and whether non covered services will be billed on a fee-for-service basis.

8 The Appendix contains a sample list of CPT/ICD-9 codes separated into two categories, "Covered" and "Not Covered ." You will need to create a similar list for your capitation contract guidelines.