The amount that the reimbursement is based on generally changes quarterly, based on reporting and is based on a large geographical area based on a range or zip codes. That is how they apply Reasonable & Customary (R&C) or Usual & Prevailing (U&P) or whatever your insurance comapny may call it. All professional services are paid at the Customary or Prevailing fee rate for the geographical area in which the service is performed--medical doctor visits too. This way they reimburse consistently and how expenses are limited to a reasonable amount. A provider can charge $52,225 for an office visit, but reimbursement is limited to the R&C or U&P amount.

The reason they paid more for the 1st visit is because an initial visit is more complex, and is billed with a different procedure code than subsequent visits. How they paid the subsequent visits is how they will probably pay the remaining visits.