Estimated Breakeven Points Assuming Various Ratios of Payor Sources and Current Procedural Technology (CPT) Billing Codes
| Relative CPT Billing Code Ratio* | Relative Payor Ratio (Medicare/Private Insurance) | |||||
|---|---|---|---|---|---|---|
| 0%/100% | 20%/80% | 40%/60% | 60%/40% | 80%/20% | 100%/0% | |
| 0% 92511 | 56 | 66 | 78 | 97 | 129 | 190 |
| 100% 31575 | ||||||
| 20% 92511 | 66 | 76 | 90 | 110 | 141 | 199 |
| 80% 31575 | ||||||
| 40% 92511 | 79 | 90 | 105 | 125 | 156 | 208 |
| 60% 31575 | ||||||
| 60% 92511 | 98 | 111 | 126 | 147 | 175 | 218 |
| 40% 31575 | ||||||
| 80% 92511 | 131 | 143 | 158 | 176 | 199 | 229 |
| 40% 31575 | ||||||
| 100% 92511 | 197 | 205 | 213 | 222 | 231 | 242 |
| 0% 31575 | ||||||
Data are presented as Q values at different payor mix and CPT code ratios. Q equals the no. of procedures required to breakeven at the end of the first year, calculated as:
where N equals the percentage of procedures performed coded as nasopharyngoscopy; L equals the percentage of procedures performed coded as laryngoscopy; M equals the percentage of procedures covered by Medicare insurance; P equals the percentage of procedures covered by private insurance; and T equals the total estimated startup costs for the first year ($12,850).* CPT code 92511: Nasopharyngoscopy with endoscope; CPT code 31575: Laryngoscopy, flexible fiber optic.
