Minnesota’s Primary Care Price Transparency Law: What Patients Need to Know

Minnesota law requires primary care providers to publicly disclose pricing information for commonly billed services, empowering patients with greater cost transparency. This article explains the details of this law, what information is available, and how patients can utilize it to better understand their healthcare expenses.

What is Minnesota’s Primary Care Price Transparency Law?

Enacted in 2018 and amended in 2020, Minnesota Statute 62J.812 mandates that primary care providers and clinics specializing in family medicine, general internal medicine, gynecology, or general pediatrics craft their pricing information accessible to the public. Minnesota Statutes, Sec. 62J.812

What Information Must Providers Disclose?

Providers are required to maintain and disclose pricing for the following:

• The 25 most frequently billed Current Procedural Terminology (CPT) codes.
• The ten most commonly billed evaluation and management (E&M) codes.
• The ten most frequently billed CPT codes for preventive services.
• For each listed service, providers must disclose:
• Their standard charge.
• The average reimbursement rate received from commercial health plan payers.
• If applicable, the Medicare allowable payment rate and the Medical Assistance fee-for-service payment rate.

The “provider’s charge” specifically refers to the amount billed to patients without private or public health insurance coverage. Minnesota Statutes, Sec. 62J.812

Where Can Patients Find This Information?

Providers must update this list annually and make it available in two ways:

• In the Reception Area: A physical copy of the price list must be posted in the clinic or office’s reception area.
• On the Provider’s Website: If the provider maintains a website, the price list must be published there. Minnesota Statutes, Sec. 62J.812

What Does This Mean for Patients?

This law aims to provide patients with a clearer understanding of healthcare costs before receiving services. However, it’s important to note that the prices listed do not represent the final amount a patient may owe. Out-of-pocket costs depend on individual insurance plans and contracted rates between the provider and the insurance company.

For a personalized estimate of costs, patients should contact their insurance company directly.

Frequently Asked Questions

Is this law applicable to all healthcare providers in Minnesota?

No, this law specifically applies to primary care providers and clinics specializing in family medicine, general internal medicine, gynecology, or general pediatrics. Minnesota Statutes, Sec. 62J.812

What are CPT and E&M codes?

CPT (Current Procedural Terminology) codes are a standardized set of codes used to identify medical procedures and services. E&M (Evaluation and Management) codes specifically represent the codes used for doctor’s visits and related services.

Does this law guarantee lower healthcare costs?

No, this law does not directly lower costs. It provides transparency, allowing patients to compare prices and potentially negotiate with their providers or insurance companies.