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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.
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New Fee Schedule
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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.
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Procedure Codes can also be added with a modifier pre-set by typing a "-" or a "." by the name.
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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.
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The Short Description will pull onto Box 43 on the UB-04 Claims Form, once it has been added to a patient's ledger.
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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.
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.
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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)
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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.
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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
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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.
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.
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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 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.
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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.
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.
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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
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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.
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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 Tab
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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.