Set Custom Self-Pay Rate or Link a CPT Code with Appointment Type [Beta Test]

Healthie enables providers and organizations to create CMS 1500s and to optionally submit them to an RCM or Clearinghouse. You'll find an overview of how to automate insurance billing workflows for your account here.

An important part of automating insurance billing workflow includes indicating which CPT codes should be automatically associated with a specific appointment. This functionality enables providers/organizations to list a CPT code with any appointment type, resulting in a CPT code automatically being added to a charting note for an appointment, or a CPT code automatically being added to a CMS 1500 for an appointment.

This article covers how to add custom self-pay rates and/or CPT codes to appointment types.

Note: This feature is currently only live for select customers (providers and organizations) who are part of our early beta-testing group. This feature does not impact your clients' experiences. Please contact your Customer Success Manager to learn more.

Add a Self-Pay Rate or Associate a CPT Code with an Appointment Type

Within account settings, users with permissions to create and edit appointment types can indicate if a specific appointment type should have either: a price set for it, or a CPT code.

A self-pay rate and a CPT code cannot be set for the same appointment type as these are two different automations (either automatically charge a client for a session, or automatically bill insurance for a session).

Some providers will create an appointment purely for self-pay clients (ie. Initial Evaluation - Self Pay) and a separate appointment type for insurance-based clients (ie. Initial Evaluation - Insurance). If you have questions on how to leverage your account for insurance billing purposes, we recommend joining our weekly recurring live class, Deep Dive: Insurance Billing.

To add a CPT code to an appointment type:

• Navigate to Provider Settings > Calendar > Appointment Types
• Click “...” beside an Appointment Type in order to make any edits

Within the appointment type settings, scroll down below the "Options" dropdown to see two tabs for pricing the appointment type. Both “Self-Pay” and “Insurance” pricing can be set, but neither is required:

1. Self-Pay: Set appointment type pricing by custom price (this is a self-pay rate)
2. Insurance: Set with CPT codes (for insurance billing)

• Select a (single) CPT code from a pre-existing list.
  • Only CPT codes from the pre-defined list will appear. We currently do not have the ability to add your own CPT codes, but if you email hello@gethealthie.com our support team can add a code to our database.
  • Note that the "Fee per unit" field is disabled. Once a CPT code is selected, the "Fee per unit" as set up in the Treatment page will be dynamically pulled in to the field.
• Set how many units of the selected CPT code should be applied to this appointment type. Please note that the value entered must be numerical. Healthie does not automatically adjust the number of units based on the actual duration of the appointment, and editing the number of "Units" will not update the price that is dynamically pulled into "Fee per unit."
• Scroll down to Update Appointment Type to apply these settings
• If you have not yet set a fee for this CPT code, the following message will appear. Learn how to add a fee for a CPT code in your account (or member) settings here.

Appointment Types List Screen Overview

Appointment Types are a central part of the Healthie Calendar configuration that allow you to showcase the sessions that you offer to clients.

The Appointment Types Overview will have two columns displaying CPT fee and Self-pay prices. If there is a CPT fee per unit or Self-pay price set, the value(s) will appear in the respective column(s), whereas if there is no CPT fee per unit or Self-pay price set, the column(s) will remain blank.

Note: If there are any potential overrides due to a provider in your organization setting a Custom Price or CPT Fee for a specific appointment type, you will see add an information tooltip appear beside your Custom Price and/or CPT Fee values.

Additional Resources

You'll find additional information on how to automate insurance billing for your account here.