Set Pricing for CPT Codes [Beta Test]

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 both an organization-wide level, and/or at the individual provider level.

Note: This feature is currently only live for select customers who are part of our early beta-testing group. Please contact your Customer Success Manager to learn more

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 Treatment 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.

The Treatment 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.

Note: If an individual provider already has a custom price set for that specific CPT code, the following alert message will pop up for the administrative user. The custom pricing will override the default organization pricing.

Set CPT Pricing at the Provider Level (Custom Pricing)

If you would like to set separate CPT fees on a per-provider basis, this can be customized.

• Navigate to Organization > Member Settings,
• Click the [...] option next to the provider
• Select the option to Edit Custom Prices in the dropdown menu.

From here, you can use the Add CPT Price option to select, and price, specific CPT codes. This pricing will only apply to this provider, and will override any pricing set for CPT codes in the account settings (Treatment Settings page).

Multiple codes can be added, each with their own set price per unit.

Use the Trash Icon to remove any set pricing.