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
- Unarchiving a Fee Schedule
- Fields and Checkboxes in a Fee
To create a new Fee Schedule, navigate to the References ability and select the Fee Schedule node in the sidebar. With the Fee Schedule node selected, click the green plus button (+).
On the right, enter the name of the fee schedule, and begin adding the codes to the newly created Fee Schedule. When finished, Command + S (or Edit menu > Save Record) to save.
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.
Adding Codes to a Fee Schedule
To add new codes to your Fee Schedule Click the green plus (+) button underneath the "Fee Schedule name" field to create a new record. Next, enter the Procedure Code and the relevant information on the right
Note: Although a user can enter anything, 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 also be added 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.
Variations of the same code can also be added to the same Fee Schedule. However, If you do this, we strongly recommend setting your Short Description to distinguish the difference between the two.
For example, you can have two D0120 codes, with one fee set with one Default Provider, and the other set to another Default Provider.
MacPractice will not allow the user to save until all of the required fields (Code, Short Description, and Unit Fee) have been entered. Once that is done, Command + S to save (or Edit menu > Save Record).
To remove a Fee Schedule from the Reference list, you have the option to archive it. Keep in mind, archived Fee Schedules can always be retrieved at a later date if needed. We recommend that you archiving Fee Schedules on your MacPractice Server computer.
To archive a specific Fee Schedule, first select its name in the References sidebar on the left, then click the red minus button (-) in the upper left hand corner of the sidebar. If there are Patients or Insurance Companies tied to this Fee Schedule, you will be prompted to ask if you wish to "Reset the Fee Schedule". Click the button to proceed.
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". Once finished, the Fee Schedule will be removed from the References sidebar.
If the fee schedule needs to be added back into the Fee Schedule Reference, navigate to the File menu at the top of your screen > Retrieve Archived > Fee Schedule. This will bring up the Unarchive window.
To unarchive the Fee Schedule, check the one you want to retrieve and click ‘Unarchive’ at the bottom right of the window. The Fee Schedule will be added back to References ability > Fee Schedule node.
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. The majority of these options are used to set default values for when you add a Charge to a patient's ledger.
Use the Fee Tab to enter all of the basic and fee information for the selected Procedure Code. A majority of this information will pull into the Charge Window as a default, but can be adjusted on a patient to patient basis.
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).
This information will pull into Box 24d on the CMS Claim Form, Box 29 on the ADA Claim Form, and Part 1 - Procedure Code area on the CDA Claim Form, once it has been added to the patient's ledger.
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.
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.
The Short Description will pull onto Box 43 on the UB-04 Claims Form, once it has been added to a patient's ledger.
A two digit, numeric code required in some medical claims in specific instances such as drug trials and experimental procedures. For more information, visit our Demonstration Code article.
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.
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).
This information will pull into Box 24f on the CMS Claim Form, Box 31 on the ADA Claim Form, Part 1 - Dentist's Fee area of the CDA Claim Form, and Box 47 on the UB-04 Claim Form.
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.
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. Units will also display on electronic claim forms.
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."
The number of units will pull into box Box 24g of the CMS Claim Form, Box 29b of the ADA Claim Form, and Box 46 of the UB-04 Claim Form.
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.
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.
This information will pull into Box 28 of the CMS Claim Form, Box 32 of the ADA Claim Form, and Part 1 - Total Charges area of the CDA Claim Form
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.
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 older, 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 > Ledger > New Charge tab has 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 amount pulls from the copay column in the Insurance sub tab of the Patient tab.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The Long Description tab will include additional text fields for the selected procedure codes. These are for the office's reference, and do not pull onto claims normally.
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.
The Notes field will pull its contents into the Notes Tab of a charge that uses this procedure code.
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.
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.
This tab will include specific information regarding anesthesia, medication, and institutions.
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.
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.
This field will pull into a UB-92 claim form's Revenue Code field and is a required field for Institutional claims.
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.