How to use the CPT Rule Setup?

Purpose:

To guide administrators in setting unit limitations for CPT codes within insurance rules, ensuring compliance with payer requirements and preventing billing errors.

Scope:

This article covers:

1. Accessing CPT rule configuration for specific insurances
2. Setting unit limits:
   1. Per individual note
   2. Per entire case 
      Excludes:
3. Creating new CPT codes
4. Global billing rules
5. Insurance-specific authorization requirements

Procedure:

1. Navigate to Insurance Rules:
   1. Open the patient's Insurance Tab
   2. Select the relevant insurance
2. Modify CPT Rules:
   1. Click Edit on an existing rule
   2. Locate the target CPT code
3. Set Unit Limits:
   1. Enter Maximum Units (per note or case)
   2. Save changes

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To set this up simply go to the Patient's Insurance Tab 

From Insurance click on EDIT to edit an existing CPT Rule 


 

Click on New to Add 

Enter the CPT code you want to restrict or set a limit for, specify the maximum allowed units, and save.