CPT Fee Schedule

This schedule allows you to indicate how much you charge for services. When a session is added, the system will automatically calculate the charge amounts based on the CPT code, modifier(s), and units.

Expected Rates (Contracted Rates)

The CPT Fee Schedule is not to be used to enter expected/contracted rates for a payer. If you are wanting to set up a schedule for Expected Rates, please see: Expected Rates Schedule.

Different Charge Amounts for Different Payers

The CPT Fee Schedule can't be used to enter different charge amounts for different payers. However, you do have the ability to have different charge amounts based on Plan Type.

The CPT Fee Schedule

Navigate to Billing > Tools > Fee Schedule. You will see a table with CPT codes as rows and Session Classes (if any) as columns. Session classes can be set up using Schedule > Classes.

Note: For WebPT-integrated members, all sessions will generate without a class. Sessions without a class will use the Default column.

Before we get into creating your expected rates schedule, let's go over some of the features on this screen.

Filters

At the top left of the screen, you can use the Provider drop-down to create a schedule for a specific provider. The Default schedule will apply to all providers who do not have their own schedule set up.

The Plan Type drop-down corresponds with the primary insurance card on a client's chart. The Default schedule will apply to all plan types that do not have a schedule set up. 

Schedules are not usually different for each provider and plan type, but you still have the option to create those schedules if desired.

Important: If you decide to create multiple fee schedules, be sure to fill them completely. If any field is left blank, the system will read that as a charge of $0.00.

Add Service Code, Class Column, Delete Schedule

You can manually add codes to this schedule by clicking Service/Row. If you want to add modifiers, that can be done at a later time.

Adding a Class/Column is the equivalent of adding a new session class under Schedule > Classes.

If you no longer want to use the schedule or you want to redo the entire schedule, you can click Delete This Fee Schedule. This will only remove the current schedule you have selected using the Provider and Plan Type.

What CPT Fee Schedule do I need to enter?

It is recommended that you fill out your Default Provider/Default Plan Type schedule for your insurance clients. For your Self Pay clients, you should create a Default Provider/Self Pay schedule.

Creating Your CPT Fee Schedule

1. Click on the cell that corresponds to the CPT Code and Session Class desired. This will expand that field. The top of the expanded area will display the Code and Class for that cell.
2. Enter the Charge amount. The Charge amount is the numerical amount that you want to bill (based on the rate type). The Rate Type options you have are Fixed Rate, Per Unit, or Per Minute.
   1. Fixed Rate - This means you are charging a flat amount, regardless of how many units you bill.
   2. Per Unit - Indicates the amount you are charging based on the specified number of units. For example, if you want to charge $50 for every unit you bill, you would enter 50 as the amount, set the RateType as Per Unit, and specify 1 unit.              
   3. Per Minute (Non-integrated clinics) - If you enter minutes on your session, you can indicate the amount you are charging based on a specified number of minutes.
3. Click Save.

Filling Columns and Rows

You will notice that when entering the rates, there are 2 links you can click. One link is labeled Fill Row Right and the other is labeled Fill Column Down. You can use these links to take what you have entered and apply it to everything in the row to the right or everything in the column below.

Different Charge Amounts for a Service Code Modifier

If you charge a different amount when a modifier is used then you will need to do a Modifier Split.

1. When you put your mouse over the row, a icon will appear to the left of the row. Click on that split icon.
2. On the Add Modifier to CPT box, enter the modifier that you wish to add to the CPT code. If you would like to add multiple modifiers, separate them using a period. Do not enter the CPT as part of the modifier.
3. Click Add Modifier. This will create a new line on the schedule.

How do I remove a code from my fee schedule?

If you would like to remove a code from your schedule:

1. Navigate to Admin > Defaults/Settings > Billing.
2. Under Your CPT Codes, locate the code and click the icon.

I have multiple CPT Fee Schedules. Which one does the system use?

The system uses a hierarchy to determine the order of codes on a session from the most specific to least specific. If the system does not find an expected rate in the first schedule, it will search the second, the third, and then the fourth. If no charge rate is found for a code, it will be treated as a 0.00 value.

1. Specific Provider/Specific Plan Type                               
2. Specifc Provider/Default Plan Type                                     
3. Default Provider/Specific Plan Type                                    
4. Default Provider/Default Plan Type