Sunset Sports Medicine Financial Policy
This page explains how billing, payments, and insurance claims work at Sunset Sports Medicine, LLC. We are committed to clear, honest communication about the cost of your care.
1. Cash-Pay Practice
Sunset Sports Medicine operates primarily as a cash-pay practice. Payment is due in full at the time of service unless other arrangements have been made in advance.
- Accepted forms of payment include cash, debit, credit, and HSA/FSA cards.
- We do not submit insurance claims on your behalf.
- You are financially responsible for all charges for professional services rendered.
2. Fee Schedule & Treatment Estimates
Our clinic maintains a transparent fee schedule for evaluations, procedures, regenerative treatments, and follow-up visits.
- Standard fees are available in-office and may be reviewed with you at your visit.
- Fees may vary based on the complexity of your condition, time spent, and materials used.
- When possible, we will provide a good-faith estimate of the cost of care before treatment.
- Certain procedures (for example, regenerative injections) may require a deposit or pre-payment.
3. Using Insurance (Self-Submission Option)
Although we do not bill insurance directly, many patients choose to seek out-of-network reimbursement.
- You may request a Superbill (itemized statement with CPT and ICD-10 codes).
- You may submit this Superbill to your insurance company for possible reimbursement.
- Coverage, reimbursement amounts, and processing times are determined solely by your plan.
- Sunset Sports Medicine does not participate in disputes or appeals with insurance carriers.
4. Non-Covered & Regenerative Services
Some services—including certain regenerative, performance, or wellness treatments—may be considered non-covered by insurance plans.
- Non-covered services are the patient’s responsibility and are payable at the time of service.
- We will inform you when a recommended service is likely to be non-covered whenever possible.
5. Cancellations & Missed Appointments
- We request at least 24 hours’ notice for canceling or rescheduling an appointment.
- Late cancellations or missed appointments may be subject to a $50 fee.
- Repeated missed appointments may require pre-payment to reserve future visits.
6. Refunds & Deposits
- Refunds may be issued only for services that were paid for but not rendered.
- Procedure deposits are generally refundable with at least 48 hours’ notice of cancellation.
- Once a service has been provided, fees for that service are not refundable.
7. Good Faith Estimates & Compliance
- Uninsured and self-pay patients are entitled to a Good Faith Estimate of expected charges, consistent with federal law.
- Our financial policies are designed to comply with applicable Arizona law, CMS guidance, and HIPAA privacy standards.
By scheduling and receiving care at Sunset Sports Medicine, you acknowledge that you have had an opportunity to review this financial policy and ask questions about your expected costs.
Fee Schedule & Payment Options
Transparent pricing for orthopedic & sports medicine services
Cash-Based Practice (You Can Still Use Insurance)
We are a cash-based practice. You pay at the time of service, and we provide a detailed receipt (a superbill) so you can submit to your insurance for potential out-of-network reimbursement paid directly to you. This model lets us spend more one-on-one time with you and keep pricing simple and predictable.
Why Third-Party Pricing May Differ
Prices billed to third-party payors (e.g., insurance) are typically higher than our Patient (Cash) rates. This reflects the additional documentation demands, pre-authorizations, appeals, claims processing, and reporting that insurers require. These administrative tasks add significant time and staffing costs. Your out-of-pocket expense with insurance depends on your plan’s deductible, co-insurance, and out-of-network benefits.
Payment Flexibility
- Payment plans: interest-free options are available to spread costs over time.
- Income-based sliding scale: available on request with simple income verification.
- Transparent pricing: what you see below is what you pay—no surprise bills.
| CPT | Description | Patient |
|---|---|---|
| 99202 | New patient, low complexity | $80.00 |
| 99203 | New patient, moderate complexity | $130.00 |
| 99204 | New patient, high complexity | $210.00 |
| 99205 | New patient, very high complexity | $275.00 |
| 99212 | Established patient, low | $65.00 |
| 99213 | Established patient, moderate | $105.00 |
| 99214 | Established patient, high | $160.00 |
| 99215 | Established patient, very high | $220.00 |
| CPT | Description | Patient |
|---|---|---|
| 20600 | Injection into small joint or bursa | $100.00 |
| 20605 | Injection into intermediate joint or bursa | $125.00 |
| 20610 | Major joint or bursa injection | $150.00 |
| 20604 | Small joint injection w/US guidance | $120.00 |
| 20606 | Intermediate joint injection w/US guidance | $150.00 |
| 20611 | Major joint injection w/US guidance | $200.00 |
| 20550 | Injection, single tendon sheath/aponeurosis | $120.00 |
| 20552 | Trigger point, 1–2 muscles | $100.00 |
| 20553 | Trigger point, 3+ muscles | $150.00 |
| 76942 | US guidance for needle placement | $90.00 |
| CPT | Description | Patient |
|---|---|---|
| 1000 | BOTOX | $16/unit |
| 1001 | Hyaluronic acid | $200/joint |
| 1002 | PRP (Platelet-Rich Plasma) | $500/site |
| CPT | Description | Patient |
|---|---|---|
| 98925 | OMT 1–2 regions | $50.00 |
| 98926 | OMT 3–4 regions | $100.00 |
| 98927 | OMT 5–6 regions | $150.00 |
| 98928 | OMT 7–8 regions | $200.00 |
| 98929 | OMT 8+ regions | $250.00 |
| CPT | Description | Patient |
|---|---|---|
| 29200 | Strapping / taping codes | $50.00 |
| 97110 | Therapeutic exercises (15 min) | $50.00 |
| 97112 | Neuromuscular reeducation | $50.00 |
| 97140 | Manual therapy techniques | $100.00 |
| 96136 | Neuropsychological testing (first 30 min) | $100.00 |
| 96137 | Neuropsychological testing (each additional 30 min) | $100.00 |
Notes: Medication/biologic pricing reflects product cost in addition to any associated procedure codes. Unit- or site-based pricing is shown where applicable. Sliding scale discounts are available upon request with income verification.