The Price list is a list of ALL CPT codes used in your clinic
and how much your clinic charges for those services, supplements, supplies etc.
Every CPT code must have a dollar value. You are unable to create a CPT without a value and add the value later when applying the charge to the patient ledger.
It is always highly recommended that a clinic have only ONE Price List. This helps prevent issues of fee splitting and attaching the wrong Price List to a patient's case.
Before creating a Price List, please make sure you are happy with your current button structure. It is more difficult and time consuming to add CPT codes one by one, rather than being able to add all your CPT codes at once (via the Copy from button structure button). To see how to set up your CPT button structure click here.
Understanding the Price List
When you first open your price list, you see this info at the top of the page. If Active is selected, you will see a list of all your active Price Lists within this drop-down. If Inactive is selected, you will see a list of all Price Lists your clinic has made inactive since using the software.
You will see an ADD CPT button. This button allows you to add a new CPT code to your already active Price List.
You will select this button after the CPT code button has already been created under your Admin section > CPT Codes.
This is typically used when a clinic is starting to carry a new supplement or starting to provide a new service for your clinic.
The Copy Current button allows you to duplicate the active Price List you are currently looking at on the screen.
This button is not used often but would be used in a situation where a clinic changes from taking insurance to an all cash practice.
For example: You may want to make a brand-new Price List for all your new patients, that has a similar baseline as your other Price List but, you may want to change your prices for some services or remove some services you previously offered.
Once done, you would inactivate the past Price List. This way only the new Price List becomes available in the dropdown of options whenever you are selecting a Price List to tie the patient to (in their file > Case tab).
This also allows your grandfathered clients to remain on your past Price List for the clinic.
Keep in mind, IF you would like to change your current patients to a new Price List, it is strongly recommended that you create a new case for that patient, add the new price list to the new case and inactivate their old case. This ensures the correct date is linked with the already applied charges and then new appointments will follow the specifications from the new Price List.
The Update price List button is used when your clinic wants to change your prices for services or supplements offered in your clinic.
For example: at the beginning of the year, you may want to increase your prices from charging $80.00 for an Adjustment to $85.00.
This button will duplicate all your CPT codes in your Price List, provide a stop date for all current CPT codes and a new Start date for the codes you are going to start to use.
Because it will duplicate, if a price of a CPT code is to remain the same, you will not touch it. You will only adjust the CPT codes that will have the new prices.
The system will ALWAYS create the stop date based on the day before you press the button and the Start date will ALWAYS be today's date.
For steps on how to update your current Price List click here.
It is extremely important that if you are going to change your fees, you come in a little early and perform this task the same day you will want the new prices to take effect. If you do not do it that way, you will have to manually adjust all start and stop dates, which is a lot of work.
The Make Inactive button allows you to make a Price List inactive.
If your Price List is being used in patients cases, it will not affect them by making the Price List inactive but, you will not be able to use this Price List for any new patients.
*If you accidentally select the Make Inactive button and your Price List disappears from your active list, that is ok. Just click on the Inactive button to view the Price List you made inactive and select the Make Inactive button again, to make active.
The Copy from Button Structure button is for new clients using the software for the first time.
This button will create a new Price List based on all CPT codes used, by your office, when creating your CPT code buttons.
It is very important that a clinic uses this button AFTER they have created all their CPT code buttons, so they do not have to add any additional CPT codes, one by one, with the ADD CPT within the price list afterwards.
The Effective date display will always default to today’s date.
This will show you all current CPT codes being used and their current price amounts.
If you uncheck the box, you will see a list of all CPT codes used in your clinic and when those prices were effective.
Now onto the Columns
You will see several columns in your Price List.
The first columns you will see is the CPT Code Column and the CPT Description column. This shows you a list of all CPT codes entered and their proper description from the CPT code Library.
You can change a description when you are creating your button structure (When you drag the CPT code to an empty button) but that description is not shown on the price list.
The Print on 1500 column is for insurance purposes.
By checking this box, it tells your software that you want this CPT code to print on a 1500 HCFA form.
If the box is not checked, the code will still apply on all patient’s ledgers/appointments but will not print on a CMS 1500 form.
For example: you will not want supplements to print on a HCFA because insurance policies do not cover supplements so, you would leave the box unchecked.
The Per Unit Amount column tells the system how much you charge for that specific service, supplement or supply you offer in your clinic.
This is the amount that will present on your 1500 form, if you are billing insurance. This amount will always be associated with your CPT button.
In your software, you are unable to apply a CPT code to a patient and then adjust the amount on the fly or create a CPT code with a $0.00 amount and then add the amount you want to charge into the appointment at the time you apply the CPT code.
The Units column will always default to 1 unit but can be adjusted if you are needing to do so.
This means that the price you supplied in the previous column is for 1 unit of that service.
Some clinics will create a bulk button for supplements say for families to use. They will put in a daily vitamin for $100.00 but change the unit number here to 4 so 4 bottles of Daily vitamins are supplied for the $100.00 price.
Please keep in mind that it is not necessary to create bulk CPTs. Even though you cannot change the price for a CPT code when applying the charge to a patient/appointment, you can adjust the Unit number.
For example: your clinic charges $25.00 for a daily vitamin and the patient wants 4, you can apply the CPT code to their account/appointment, change the unit to 4 and the system will multiply the amount due. 25.00 X 4= $100.00
The Policy Overrides column is for clinics that are billing Insurance Payers.
If you have a CPT code that was created for a specific insurance payer or the CPT code must follow specifics for all payers, you can set specific Policy limits.
Patient Responsibility- You can apply a specific % of patient responsibility. This tells the system that no matter what insurance policy limits are set forth in their insurance snapshot, this percentage of this CPT code will always go to the patient’s responsibility to pay.
For example, if a patient is covered at 80%, the system will split charges so that 80% shows as the insurance company’s responsibility and the 20% will show as the patient’s responsibility. But, if the patient buys a supplement that is not going to be billed to the insurance company, you will want to override that insurance policy for all supplements and tell the system to make the “Patient responsible for 100%” of the charge.
Co-Pay: The system auto applies the copay indicated in the patient’s insurance snapshot to any charge that took place within a date of service (typically the most expensive charge). This area allows a copay amount to be set for a specific charge. Maybe their policy always applies the co-pay to therapies instead of adjustment charges.
You can say this copay amount is in addition to what the insurance policy limits are in their insurance snapshot or this is the only copay amount for that specific date of service.
You can also tell the system if the copay amount is applied to the deductible.
The Sales Tax column allows you to apply sales tax to a specific CPT code if your state requires you to charge sales tax for a specific service, supplement etc.
This column will default to none but, by clicking on the provided location, you can select who is to pay the sales tax applied.
Patient Responsibility- this means whether the patient has insurance or not, the patient is required to pay the sales tax for this CPT code
Payer Responsibility- this means when an insurance policy is present on the patient’s case, the insurance payer is required to pay the sales tax for this CPT code.
The Appointment Required column tells the system if it is necessary for the patient to meet with a provider to receive a service.
If this box is checked, the system will not allow you to use this CPT code in the OTC area of your software toolbar to apply the CPT code directly to their ledger.
In most cases, you will not see this box checked for things like supplements, so a patient can pop into the clinic and buy a multivitamin because they ran out, without having to be seen by the doc.
The Do not copy to next visit column, allows you to tell a CPT code to not copy to the patient's next future appointment.
This column is there to help save time.
Things like Adjustment codes have this box unchecked, so any future scheduled appointment will have the correct adjustment code already applied to their appointment because it will carry from the most recent completed appointment.
This box is typically checked for things like Exam codes, X-rays or supplements because those are services that are not done on each visit.
If you have several appointments for a specific patient, saved without the charges and you must go back and review the appointment to place in a CPT code that is set to carry over then YOU MUST go into each saved appointment to add in the charges.
The system WILL NOT carry over the charges when the appointment for past appointments that have already been completed.
Once your appointments become current and the CPT code is added and set to carry over, your next scheduled appointment WILL display the CPT code.
The Start Date column tells you when a CPT code is effective.
This Column is very important because if a date of service falls before this date, you will not be able to apply this CPT code to the patient's ledger or any appointments that took place before this date.
The Stop Date column show when a CPT code was expired and is no longer able to be used.
The system keeps a record of CPT start and stop dates, so a patient's account will always display the correct amount the clinic charged for service, during a specific time frame.
The Add Modifier column allows you to attach a modifier to a specific CPT code.
If a Modifier is added to a CPT code in the Price List, then whenever that CPT code button is pressed within the appointment, the modifier selected will be automatically attached.
When you click on the 3 dots in the column, a window will appear with a list of available modifiers to choose from.
To apply a modifier, you will find your modifier in the list, select and click OK button to apply.
There is an ‘Add’ button if you do not find the one you are looking for and need to add it to the available list of modifiers to apply.
You can edit a modifier on the list by clicking the Edit button within the Modifier window.
Delete button- to delete a modifier you may not use in your clinic.
Lastly, the Remove column is there to delete a code off the Price List, if it was added in error.
You WILL NOT press this button if the CPT code has been applied to a patient's ledger or appointments.
I can’t stress this enough…. Please DO NOT press this button if the CPT code has been used!! Just place in an end date so it cannot be used for any future charges.
How to Create a "New" Price List
Please NOTE: You CANNOT edit the name of your Price List after it has been created and tied to your Patients. You would need to create a new Price List with the New name, then tie the new Price list to ALL patients
- Step 1: Go to Administration area
- Step 2: Select Price List
- Step 3: Select the “Copy from Button Structure” button
- Step 4: Create a name for new Price List, and select “Save”
This option will take ALL of the CPT codes that are already programmed onto your CPT buttons and use them to create a new Price List.
After your new Price List is created, you will then make the appropriate modifications to each line item as needed, and then select the “Save” button at the bottom of the page to save your changes.
- Adding a CPT Code AFTER the Price List has been Created-
If you add any new CPT codes to your button structure after creating your initial Price List, you must go into the Price List again to add that CPT code.
Please follow the steps below to add your new CPT Code to your existing Price List
How To "ADD" A New CPT Code To Your Existing Price List
- Step 1: Go to Administration area
- Step 2: Select Price List
- Step 3: Make sure you are looking at the correct Price List, that you are wanting to add the New CPT code to and Select Add CPT
- Step 4: In the window that comes up, search for the new CPT code
- Step 5: Once you see the new CPT code you created, select to highlight and press “Save”
- Step 6: Now scroll to the bottom of your Price List to find the new code
- Step 7: Add in all the necessary info for your New CPT code including whether or not you want the CPT to be printed on a HCFA, if you want to override any insurance policies, if there is any sales tax associated with the CPT and how it should be distributed, if an appointment is required to charge the CPT, and/or if you would like that CPT copied from visit to visit. The Start date will default to the date you created the Price List.
(The Start Date Selected should be BEFORE the first date of service you are wanting to apply the CPT code to)
***IF you have Fee Schedules created for your Insurance Payer Allowed Amounts, please go to Admin>>Fee Schedules>> Select proper payer>> Select correct Fee Schedule from the drop-down and follow the same steps to add the CPT code and add in the New Allowed Amount.
How to update your Price List
It is extremely important to perform this action BEFORE you need the new prices to take effect. Doing it after creates A LOT more work.
- Step 1: Go to Administration area
- Step 2: Select Price List
- Step 3: Select "Update Price list" button
- Step 4: A window will generate asking you to select a start date.
It will default to Today's date.
(you can select any date in the future but not a date in the past)
This will duplicate ALL charges inside the Price List to start from today's date or future date selected.
All previous charge amounts will be displayed. If the amount of a charge stays the same, you will not need to modify it.
You will now change any CPT amounts that need to be changed and select “Save”.
* NOTE: If you selected a date in the future:
- You will not see your duplicate CPT codes generated because you selected a date in the future.
- To see the NEW Price List - please go to the top of the screen and un-check the box next to the Effective date calendar to display all dates.
Then select "Save"
* You will have to change all "Start Dates" on new charges and "Stop Dates" if you are updating the price list "after" the amounts were changed. As it will automatically generate today's date for the start date and yesterday’s date for the stop date. There is no way to select a date in the past for the start date. That is why it is suggested that this action take place the day you would like changes to be made (or a future date) as it will cut down the amount of work an office will have to perform.
- Support Information -
If you have any questions or need assistance with this process please contact Support by:
Live chat: Click the 'Support Portal' button in your main toolbar (on left-hand side), click the green 'Support' box in bottom right of screen.
***This has the fastest response time***