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
- Duplicating an Existing Fee Schedule
- Adding Codes to a Fee Schedule
- Archiving a Fee Schedule
- Fields and Checkboxes in a Fee
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.
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 some of these codes via the Codes Managers feature, which is a purchasable option on your MacPractice license. This specifically includes ADA and HCPCS codes. 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).
Archiving a Fee Schedule
Within the next window, be sure to check all of the Patients/Insurance Companies listed within the two tables. Below each table choose the Fee Schedule you want as the new default for your Patients/Insurance. When you are finished, click ‘Update & Archive’.
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.
- Code: The identifier for the fee. If submitting claims to insurance, procedures codes must be valid and meet insurance requirements (in the United States, for example, ADA, CPT, or HCPCS coding systems should be used).
- Alias: An alternate identifier for the fee. An alias may be entered en lieu of a code anywhere codes are entered in MacPractice (i.e. the Code field in the New Charge window of the Ledger). An alias is often a shortened code or easy-to-remember abbreviation of a Short Description.
- Short Description: The name of the fee, procedure, or service. The short description is the Code in layman's terms. This does not affect claims and should therefore be something that makes sense to the user and is easily searchable. When entering codes in a patient's file in MacPractice, if the code or alias is unknown, the user can search for the code by short description.
- Demonstration Code: A two digit, numeric code required in some medical claims in specific instances such as drug trials and experimental procedures
- Cross Code: Providers who send both medical and dental claims, such as oral and maxillofacial surgeons, may need to use a combination of ADA and CPT codes in the office fee schedule. In some cases, the dental code has an equivalent medical code that needs to be used when submitting medical claims.
By utilizing the cross code feature in the fee schedule, MacPractice will use the appropriate code, based on whichever claim form you print/submit. This ensures you do not have to duplicate procedures in your patient's ledger or in your fee schedule.
If you are running MacPractice DDS, the medical or CPT code is entered as the Cross Code and the dental or ADA code is the default Code.
For MD, DC, & 20/20 the steps remain the same, however, the dental or ADA code is entered as the Cross Code and the medical or CPT code is the default Code.
- Unit Fee: The price of the fee (or of a single unit of the fee, if using Units). The unit fee is what your office is charging the patient (and their insurance).
- Fee Calculations: (Fixed or Units) A fixed fee calculation is a flat rate fee for the procedure. A units fee calculation will enable the Unit Type popup and allow the user to enter a number of units with the fee in the patient's chart in order to multiple the Unit Fee by the number of Units. A fee set to calculate by Units will affect your inventory count, if the tied item is set to "Scale to Units".
- Unit Type: (Hours, Minutes, Sessions, Other) This field defines what a unit represents when we enter a number in the Units field. The Unit Type popup is only usable when setting the Fee Calculation to Units. The Unit Type represents how we are charging the patient. For example, $X for X hours or minutes of work.
- Units: The user may set a default number here that will be used when selecting this procedure code when creating a new charge. Whenever the fee is entered in a patient's file, the units will default to this number, but can be changed on a patient by patient basis as needed.
Fee Calculations must be set to Units in order for the Units field to be used.
Units entered multiple the Unit Fee to get the patient's total balance for the fee. Equation: Unit Fee X Units = Total Fee. For fixed fee calculations, Units are "1." Units will display on electronic claim forms.
- Unit Cost: The total cost to your practice for one single unit of this fee. The Unit Cost is a column in the Production Detailed by Procedure report. The value displays as an overall total, per code, and per individual instance of a code.
- 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: (Relative Value Units) RVUs reflect the relative level of time, skill, training and intensity required of a physician to provide a given service. RVUs therefore are a method for calculating the volume of work or effort expended by a physician in treating patients. A well patient visit, for example, would be assigned a lower RVU than an invasive surgical procedure. Given this relative scale, a physician seeing two or three complex or high acuity patients per day could accumulate more RVUs than a physician seeing ten or more low acuity patients per day. “Work,” rather than number of patients or billings, is the behavior being measured and rewarded. Work RVU is a column in the Production Detailed by Provider Report and is totaled for each provider and overall. The American Academy of Professional Coders has an RVU calculator and other helpful information on their website (https://www.aapc.com/practice-management/rvu-calculator.aspx).
- Schedule Units: The value entered here is designed to indicate how many units of a patient appointment to schedule for the procedure. This will set the default in the new charge window when you enter a fee for a patient. In MacPractice 7.3 and lower, this value then displays in the Transactions and Treatment Plan ledgers in the "Time" column.
- Require Co-Pay Checkbox: This checkbox will ensure the matching box in the New Charge window will be checked when the charge is entered into the ledger. Copay amount is displayed at the bottom of the window and the copay is taken into account with insurance estimating. If the preference to open a payment window after entering a new charge is enabled, the payment window will have the copay box checked and the payment amount will be the amount of the copay automatically. (The copay pulls from the copay column in the Insurance sub tab of the Patient tab.)
- Taxable Checkbox: Typically used with sold items, the Taxable checkbox indicates that a tax may be charged along with the fee. Checking this box will display the Tax Type popup menu, which is hidden otherwise.
- Tax Type: This drop down only appears when the "Taxable" checkbox is checked. This allows you to select from a defined Tax Type, which is set in the References Ability > Tax Type node.
Tax Types cannot be created without a Tax Rate (in the form of a percentage amount, down to the thousandth place). Details on creating and using Tax Rates and Types can be found here: https://helpdesk.macpractice.net/hc/en-us/articles/218423717-Tax-Rate-Tax-Type
- 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: (TOS) This indicator is required for medical claims in the United States since 1995. This list includes all the valid TOS Indicators and the available options cannot be altered. Indictors go on claim forms in the form of a single letter or number that has a corresponding meaning. Both the indicator and its description are listed in this popup menu. This will set the fee's default TOS.
- 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: This field sets the fee's default Place Of Service Code. Place of Service Codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. CMS maintains POS codes used throughout the health care industry. This code set is required for use in the implementation guide adopted as the national standard for electronic transmission of professional health care claims under the provisions of HIPAA. The POS code and its description are included in the popup menu.
- 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, and does not have any impact on how a particular code is handled for the purposes of insurance estimation.
- 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.
Marking a fee as "Patient Responsible" will prevent that fee from being included on an insurance claim. For Insurance Estimating, MacPractice will always estimate the open balance of a patient responsible charge to be the patient's responsibility and not the insurance company's.
- 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: With this box checked, the Area of Oral Cavity dropdown menu in the new charge window of a patient's ledger will be required. MacPractice will prevent the user from saving this charge to a ledger if the area of oral cavity is not selected. The title of this section in the New Charge window will be written in red text as an indication.
- 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: The MIPS checkbox allows 0.00 charges to go on claims for Medicare.
- Medically Necessary Checkbox: Adds required qualifiers to eClaims when there's a referral on the claim. This is used exclusively for podiatry.
- Require Description on eClaims Checkbox: Used when the procedure code is NOC (Not otherwise classified). These are CPT codes that usually end in 99. The code itself can be used any number of ways, so the short description of the fee shows up in the claim along with the procedure code. It is iffy though. Some payers want that. Others only want a procedure level note. Most payers will reject if there is both a note and a description on the claim.
- Automatically Estimate Unit Cost Checkbox: Enable this checkbox to automatically calculate the unit cost based on the cost of the associated inventory item(s) and how many inventory items are used.
- Lab Sub Tab
- Require Lab Checkbox: With this box checked, a Lab will be required in the new charge window of a patient's ledger when entering the fee. MacPractice will prevent the user from saving this charge to a ledger if a Lab is not added. The title of this section in the New Charge window will be written in red text as an indication.
- Lab Table: The Lab Table allows you to add a Default Lab to this particular Fee. Simply click the Green Plus or the Red Minus to add or remove a Lab to this Fee.
- Lab Costs: The Lab Costs field allows you to set a default Lab Cost for this particular Fee. Lab Costs are the service fees that a lab might charge for conducting a service. Lab Costs are not included in the charge amount, and will be tallied in Production reports.
- Material Costs: The Material Costs field allows you to set a default Material Cost for this particular Fee. Material Costs are the estimated cost of the physical materials to conduct the lab, i.e. syringes, gloves, etc.
- Facility Sub Tab
- Facility Table: The Facility Table allows you to set a default facility for this particular Fee. Facility References are used to provide a solution for an Office that may perform services at a remote location, such as another office or a hospital, but those services fall under the Office's Tax ID. This allows the Office to keep separate records and show services rendered at the facility location.
- Long Description: The Long Description field contains a large text field to more thoroughly describe a procedure and any associated details. This information is not printed on a claim form when generating claims.
- Notes: The Notes field will pull its contents into the Notes Tab of a charge that uses this procedure code.
- Usage Notes: This field is another large text field that allows you to write in notes regarding the usage of this particular Fee. This information is not pulled into claim forms when generating claims.
- Clinical Notes: This field will pull its contents into a Clinical Note into the Dental Tab of the Patient Ability whenever this Fee is used in a New Charge.
- Anesthesia Checkbox: This checkbox toggles the subsequent Anesthesia fields so you can edit them. This also flags the Fee in question as an Anesthesia Fee. Click here to learn more about Anesthesia Billing. We strongly recommend reading this article before proceeding with configuring Anesthesia fees.
- Anesthesia Base Units: The initial anesthesia amount used to induce an anesthetic state.
- Anesthesia Minutes/Unit (Hour 0-4): Indicates the number of minutes per unit for the first 4 hours of Anesthesia.
- Anesthesia Minutes/Unit (Hour 4+): Indicates the number of minutes per unit for every hour after the first 4 hours of anesthesia.
- Medication/NDC Table: This table allows you to tie a Medication to a particular Fee. This is particularly useful if your fee always uses the same medication with the same NDC number. You can only associate one medication to a given Fee. Any adjustments to a Medication must be done from the Medication Reference.
- Revenue Code: This field will pull into a UB-92 claim form's Revenue Code field and is a required field for Institutional claims.
- Rate Code: This is primarily used in some institutional eClaims when it is required.
- 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.