Set Pricing for CPT Codes [Coming Soon]
Healthie enables providers and organizations to create CMS 1500s and to optionally submit them to an RCM or Clearinghouse.
An important part of automating insurance billing workflows, includes associating individual CPT codes with a per unit fee. This allows for Healthie to automatically add billing items to a claim.
You'll find an overview of how to automate insurance billing workflows for your account here.
This article covers how to set a price for a CPT code (one price per CPT code) within your account, on an organization-wide level.
Note: This feature is not currently live for customers.
Once you've set your pricing for CPT codes, you can go ahead and indicate which appointment types should be associated with specific codes. Learn more here.
Set CPT Pricing at the Organization Level (Default Pricing)
If there is standard pricing per CPT code that your organization would like to use, the first part of the insurance and billing automation process is defining CPT pricing on a global default level. This entails a provider and/or administrator defining CPT prices for all providers and for all appointment types as defaults.
- Navigate to Provider Settings (gear Icon)
- Under Business, select Services from the left hand navigation
- Click + Add to add to the list of CPT codes that are associated with a specific rate.
- CPT Code Name, add a CPT code from a pre-existing drop-down list. If a code is not listed, please email hello@gethealthie.com and our Support team can add this code to the database.
- Price Per Unit, an administrative user can define a price per unit (numerical value) for that CPT code. This is not a price per session, but per unit. Please refer to your fee schedule, or your standard fee.
- Save Changes to set this pricing.
This pricing will be used as the default rate whenever this CPT code is added to a claim, regardless of the provider. If you have providers that will use the same codes, but billing different rates, you'll find additional steps in the section below.
Can't access the Services Settings page, or add CPT code pricing? Please contact an account admin to request the correct user permissions are enabled for your account. You'll need to have the ability to "View and edit settings that impact the organization" enabled.
The Services Settings page will display all CPT codes that have established pricing.
Click the “…” option next to a code to Edit or Delete the CPT pricing.
