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References - Fee Schedules

This article is currently being revised. You'll see some weirdness as we tweak language, add detail, and in general try to improve things. We apologize for our construction dust. If you have any questions, don't hesitate to contact MacPractice Support!

The Fee Schedules Reference contain all of your Fee Schedules, which are lists of procedures and information associated with those procedures that your office conducts. This includes the fee amount, procedure types, and much more. You can have as many Fee Schedules as you wish.

Multiple Fee Schedules can be created for cases such as changing fees for each year without losing the prior year's records, handling fees differently for individual insurance companies, a fee schedule used for patients without insurance, and so on.

Fee Schedules can be created from scratch, or by duplicating an existing fee schedule via the Edit Menu. Duplicating a Fee Schedule will bring forward all charges and data from the original Fee Schedule, allowing a user to easily make adjustments. This is most commonly used for making adjustments from year to year.

For large-scale changes, there are several Database Utilities which can be used to modify existing Fee Schedules. For more information, see Updating the Fee Schedule and Updating the Patient's Fee Schedule in the Database Utilities topic.

If you would like to create a fee schedule that will not increase your production numbers, see How to create a Non-Production Fee Schedule.

New Fee Schedule
To create a fee schedule, navigate to the References ability and select the Fee Schedule node in the sidebar. With the Fee Schedule node selected, you can click the plus button to create a new record. You can then use the "Fee Schedule Name" field to name the Fee Schedule. Remember to press "Command-S" to save your newly created Fee Schedule.
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Duplicating an Existing Fee Schedule
Duplicating a fee schedule is useful when you want to make a few changes to a fee schedule while retaining the original copy. Primarily this is done when you're updating your fee schedule for the next year.
To duplicate a fee schedule, go to References and select the Fee Schedule node, like you would to create a new schedule. Select the fee schedule you wish to duplicate, then go to the Edit menu and select Duplicate Record.
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Adding Codes to a Fee Schedule

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To add new codes to your Fee Schedule:

  • Click the Plus button underneath the "Fee Schedule name" field to create a new record.
  • Enter the Procedure Code.
    • You can enter anything, but it is important to note that Procedure Codes are used on claim forms, so any procedures submitted to insurance should be using codes recognized by insurance companies, such as ICD-10 or CDT codes.
    • Procedure Codes can be obtained from books and websites. MacPractice can also provide these codes via the Code Manager feature, which is a purchasable option on your MacPractice license. If you have purchased the Code Manager feature in MacPractice you can go to Managers > Codes Manager. For instructions, please refer to our Codes Manager article.
    • You can add a procedure code with a modifier pre-set by typing a "-" or a "." by the name. For example, if I wanted to add procedure code D0120 with a modifier of 15, I would simply type "D0120-15" or "D0120.15" to the field. 
      • Warning: If you do not want to pre-set a modifier, do not add a dash "-" or a period "." to a code!
    • You can add variations on the same code. For example, you can have two D0120 codes, with one fee set with one Default Provider, and the other set to another Default Provider. If you do this, we strongly recommend setting your Short Description to distinguish the difference between the two.
  • Enter the description of the procedure code. This description will appear when selecting codes, allowing you to distinguish between identical codes with different configurations.
  • Enter the Unit Fee (what your office is going to change for the procedure code).
Once these basics are complete, you can then save your new Procedure Code. 
 
Fields and Checkboxes in a Fee
This section covers all configuration options and their purpose for a specific Procedure Code. These are split into the tabs each option are located in. Many options 
 
Fee Tab
  • Code: The Procedure Code of the Fee.
  • Alias: An Alias can be considered a short-hand or replacement. By typing an alias into the Code field of the Charge Window in the Ledger, it'll pull up this Code.
  • Short Description: The Short Description of the Procedure Code in question. This displays when selecting the Code when adding it to Ledger Charges and is also reproduced on claim forms typically.
  • Demonstration Code
  • Cross Code
  • Unit Fee: Part of the Fee for the Code in question. This, combined with the Fee Calculation field, makes up your Fee.
  • Fee Calculations: This field allows you to determine how your actual Fee is calculated. You can choose between Fixed and Units.
    Fixed will disable the Unit Type and Units fields, and will simply take the Unit Fee and make that the Actual Fee.
    Units will instead enable the Unit Type and Units fields, and will calculate
  • Unit Type
  • Units
  • Unit Cost
  • Fee: The actual Fee Amount. This field is greyed out and cannot be edited manually. It is calculated based on the Unit Fee and the setting in Fee Calculations.
  • Work RVU
  • Schedule Units
  • Require Co-Pay Checkbox
  • Taxable Checkbox
  • Default Provider: This field will set a Default Provider for the Fee/Code in question. Whenever you add this code to a patient's ledger, the Provider field in the Charge Window will default to this selected Provider.
  • Type of Service
  • Procedure Type: This determines the default Procedure Type of the Code in question. Procedure Types can impact insurance balance portions, depending on how your Insurance Company references are configured and whether you have Insurance Estimating enabled.
  • Default Office: This field will set a Default Office for the Fee/Code in question. Whenever you add this code to a patient's ledger, the Office field in the Charge Window will default to this selected Office.
  • Place of Service
  • Procedure Category: This field determines the default Procedure Category for the Code in question. Procedure Categories are simply used as an organizational tool for the Office.
  • Recall Type: This field allows you to set a default Recall Type, which automatically creates a Recall/Follow-Up if the Code is added to a patient's ledger. More information about Recalls can be found here.
  • Patient Responsible Checkbox: This checkbox makes the Patient Responsible checkbox checked by default in the Charge Window whenever this Code is entered, which can have insurance implications, as well as shifts the charge's balance entirely to the patient portion. 
  • Emergency Checkbox: This checkbox makes the Emergency checkbox checked by default in the Charge Window whenever this Code is entered.
  • Require Area of Oral Cavity Checkbox
  • Require Surface Checkbox: This checkbox makes the Surface field a required field when entering this Code into the Charge Window of the Ledger.
  • Require Tooth Checkbox: This checkbox makes the Tooth field a required field when entering this Code into the Charge Window of the Ledger.
  • MIPS Checkbox
  • Medically Necessary Checkbox
  • Require Description on eClaims Checkbox
  • Automatically Estimate Unit Cost Checkbox
  • Lab Sub Tab:
    • Require Lab Checkbox
    • Lab Table
    • Lab Costs
    • Material Costs
  • Facility Sub Tab
    • Facility Table
Long Description Tab
  • Long Description
  • Notes
  • Usage Notes
  • Clinical Notes
Specialty Tab
  • Anesthesia Checkbox
  • Anesthesia Base Units
  • Anesthesia Minutes/Unit (Hour 0-4)
  • Anesthesia Minutes/Unit (Hour 4+)
  • Medication/NDC Table
  • Revenue Code
  • Rate Code
Consumed Items Tab
  • Consumed Items Table: This table links up with Items in the Inventory Ability.
    Any added items will be deducted from Inventory counts when this code is added to a patient's ledger.
    You are able to adjust the quantity that will be deducted, whether the item is Consumed or whether it is Sold and thus can be returned, and whether the item will scale if the Fee is set to sell per unit.
 
Fee Schedule Associations
There are many places in MacPractice where you can assign a fee schedule to a record. This document outlines all these fields, and what they affect.
 
Modifiers
Modifiers are used to specify differences in Procedure Codes. MacPractice will display up to four Modifiers. To add modifiers, in the Code box type in the Code, then either a dash "-" or a period "."
For example, if I wanted to add Procedure Code D0120 with a modifier of 1A, I would type in the Code field "D0120.1A", or "D0120-1A". MacPractice will place the Modifiers in the correct boxes near the code in the New Charge window and populate in the order in which they were added within the Reference.
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