Procedure Fees

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Name — Enter a unique name for this fee schedule.
3. Effective date — Enter or select the date that the schedule takes effect for this payer. Blank implies a date in the indeterminate past.
4. Expiration date — Enter or select the date that the schedule expires. Blank implies a date in the indeterminate future.
   Note: You must select at least one date, either an effective date or an expiration date.
5. Allowable category — Select All, Selected global, or Selected local.
   If you select Selected global or Selected local, select the category or categories for which this schedule applies.
6. Department — Click All, or click Selected.
   If you select Selected, select the departments for which this schedule applies.
7. Notes — Enter any notes about the fee schedule.
8. Click Save. The system assigns a unique numeric ID to the new schedule. The schedule appears in the list below.

Using an Excel file that you create, athenahealth can upload the fee schedule to the new schedule name that you created. See To request that athenahealth upload a fee schedule.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Locate the fee schedule in the list.
3. Click the update link.
   The input fields appear at the top of the page.
4. Edit the fields as needed.
5. Click Save.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click the edit procedure fees link for the schedule that you want to update.
   The Procedure Fees page appears.
3. Look at the heading at the top of the page to verify the payer and name for this schedule.
   If you are viewing the wrong schedule, click the Fee Schedules link in the Task Bar.
4. Click Add New.
   The Add Procedure Code view appears.
5. CPT/HCPCS code — Enter the procedure code.
6. Press the Tab key on your keyboard.
   The values for the Description and Procedure code group fields appear automatically if the fee already exists in one of your fee schedules. (If these values do not appear, it means that you mistyped the procedure code. Correct the procedure code and try again.)
7. Patient-facing description — You can use this field to create a procedure code description that appears on billing statements. This description overrides the regular procedure code description on billing statements.
   Note: Please keep these descriptions updated and easily readable for patients.
8. Amount — Enter the fee for this procedure.
9. Miscellaneous billing section — Select this option to make this procedure available on the Claim Billing Tab in the Add Services list of procedures.
10. UDS visit — The default value of this field (Default) indicates that this procedure code qualifies — or does not qualify — a visit as UDS eligible based on the default value specified in the CPT Inclusion-Exclusion list on the Success Community. The default value — Yes or No — appears below the field. To override the default value specified in the CPT Inclusion-Exclusion list, select one of these options:
• Yes — This procedure code qualifies a clinical encounter as a UDS visit in your UDS reports.
• No — This procedure code does not qualify a clinical encounter as a UDS visit in your UDS reports.

Note: This field appears only if your organization has at least one department designated as a federally qualified health center (FQHC) on the Department Government Designations page. For more information, see the Field Reference.

11. Enter information for any additional fields (see the Field Reference).
12. Click Save.
    Note: You can view the CPT code and its description in the billing summary.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click the edit procedure fees link for the schedule that you want to update.
   The Procedure Fees page appears.
3. Look at the heading at the top of the page to verify the payer and name for this schedule.
   If you are viewing the wrong schedule, click the Fee Schedules link in the Task Bar.
4. Procedure code lookup or Procedure description lookup — Enter the procedure code or exact description and then click Filter, or click Show All to display the complete list of procedure codes in the schedule.
5. Click the update link for the desired procedure code.
   The Edit Procedure Code view appears.
6. Edit the fields as needed.
7. Patient-facing description — You can use this field to create a procedure code description that appears on billing statements. This description overrides the regular procedure code description on billing statements.
   Note: Please keep these descriptions updated and easily readable for patients.
8. Procedure code group — You can use this field to assign the procedure code to a procedure code group. You can assign a procedure code to a procedure code group for the default schedule or for a specific payer.
9. Revenue code — If your practice has the UB-04 billing feature enabled, you can type a period to access the Revenue Code Lookup tool to populate the Revenue code field.
10. Click Save.
    Note: You can view the CPT code and its description in the billing summary.

athenaOne automatically determines UDS visit types based on procedure code and provider. You can see which procedure codes qualify a clinical encounter as a UDS visit in the CPT Inclusion-Exclusion list on the Success Community. You can override the default classification of a procedure code using the UDS visit field.

Note: The UDS visit field appears only if your organization has at least one department designated as a federally qualified health center (FQHC) on the Department Government Designations page.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click the edit procedure fees link for the schedule that you want to update.
   The Procedure Fees page appears.
3. Look at the heading at the top of the page to verify the payer and name for this schedule.
   If you are viewing the wrong schedule, click the Fee Schedules link in the Task Bar.
4. Procedure code lookup or Procedure description lookup — Enter the procedure code or exact description and then click Filter, or click Show All to display the complete list of procedure codes in the schedule.
5. Click the update link for the desired procedure code.
   The Edit Procedure Code view appears.
6. UDS visit — The default value of this field (Default) indicates that this procedure code qualifies — or does not qualify — a visit as UDS eligible based on the default value specified in the CPT Inclusion-Exclusion list on the Success Community. The default value — Yes or No — appears below the field. To override the default value specified in the CPT Inclusion-Exclusion list, select one of these options:
• Yes — Select this option to indicate that this procedure code qualifies a clinical encounter as a UDS visit in your UDS reports.
• No — Select this option to indicate that this procedure code does not qualify a clinical encounter as a UDS visit in your UDS reports.
• Default — Select this option if you previously set this field to Yes or No but now want to reset the behavior of the procedure code to the default value specified in the CPT Inclusion-Exclusion list.

Note: For more information, see Using the UDS Visit Inclusion report on the UDS Reports page.

7. Edit other fields as needed.
8. Click Save.
   Overnight, athenaOne reclassifies the applicable visits as either UDS-eligible or not since the beginning of the calendar year. athenaOne makes no changes to visits with a UDS visit type service type add-on override.

You can view an audit history for all procedure codes on the Fee Schedules page. The audit history lists the changes made to the procedure code, when, and by whom. With the audit history, your practice no longer needs to keep manual change logs for your procedure codes.

The audit history can help you to understand and resolve potential claim issues. For example, if a claim is held because it is missing required procedure code information, your practice can look at the audit history for the relevant procedure code to see whether anyone deleted or modified the data recently.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click the edit procedure fees link for the schedule that you want to update.
   The Procedure Fees page appears.
3. Look at the heading at the top of the page to verify the payer and name for this schedule.
   If you are viewing the wrong schedule, click the Fee Schedules link in the Task Bar.
4. Procedure code lookup or Procedure description lookup — Enter the procedure code or exact description, and then click Filter, or click Show All to display the complete list of procedure codes in the schedule.
5. Click the update link for the desired procedure code.
   The Edit Procedure Code view appears.
6. To see the audit history, click show history at the bottom of the page.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click the edit procedure fees link for the schedule that you want to print.
   The Procedure Fees page appears.
3. Click the Download(CSV) button.
   Excel opens and displays your fee schedule information.
4. Print the fee schedule from Excel.

When you enter a procedure code on the basic or advanced view of the Charge Entry page or on the Claim Edit page, athenaOne copies all related NDC information from the fee schedule onto the claim, including:

• Procedure code description
• NDC number
• Drug dosage

You can edit the dosage information on the claim at charge entry time and from the Claim Edit page.

Note: When a provider documents the administered NDC information on a vaccine or medication order during an encounter, athenaOne populates that NDC information for a single procedure code on the Claim: Billing tab and the Claim: Charge Entry tab. If a discrepancy exists between the NDC information documented in the encounter and the NDC information configured for the procedure code in the fee schedule, a message appears. Review the information to make sure that you submit the claim correctly.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click edit procedure fees for the schedule to update.
   The Procedure Fees page appears.
3. Procedure code lookup or Procedure description lookup — Enter the procedure code or exact description and then click Filter, or click Show All to display the complete list of procedure codes in the schedule.
4. Click the update link for the procedure code to update.
   The Edit Procedure Code view appears, with the value of the CPT/HCPCS code field displayed.
5. Description — This field is used to populate the Drug name field on the NDC service type add-on.
6. Scroll down to the NDC Information heading.

Under the NDC Information heading

7. NDC Number — Enter the NDC number. You can find this number on the drug label, or you can use the Code and Knowledge Base to find it.
   When you enter a valid number in the NDC Number field, athenaOne displays the corresponding athenaCodesource trade name to the right of the field. This allows you to confirm that the NDC number entered is correct for the procedure code.
   Note: NDC is an 11-digit number with the format "xxxxx-xxxx-xx." If one segment is not formatted correctly, add a leading "0" to that segment (for example, 12345-123-12 becomes 12345-0123-12). For more information, see NDC number formatting.
8. Unit price — Enter the unit price that your practice pays for this drug.
9. Dosage — Enter the dosage amount and select the unit of measurement for dispensing this drug.
   Note: You can edit the dosage information on the claim at charge entry time and from the Claim Edit page.
10. Click Save. A message warns you that this NDC will overwrite any previous NDC for this procedure code in all of your practice's fee schedules.
11. Click OK.

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules. Or display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click edit procedure fees for the schedule that contains the procedure code.
3. Search for the procedure code to update, or click Show all to show all procedure codes.
   The current ambulance base rate type appears in the Ambulance Base Rate Type column.
4. Click the update link for the procedure code.
   The update view appears.
5. Ambulance Base Rate Type — Select the appropriate value.
6. Click Save.

When you enter a procedure code on the basic or advanced view of the Charge Entry page or on the Claim Edit page, athenaOne copies all related NDC information from the fee schedule onto the claim, including:

• Procedure code description
• NDC number
• Drug dosage

You can edit the dosage information on the claim at charge entry time and from the Claim Edit page.

Note: When a provider documents the administered NDC information on a vaccine or medication order during an encounter, athenaOne populates that NDC information for a single procedure code on the Claim: Billing tab and the Claim: Charge Entry tab. If a discrepancy exists between the NDC information documented in the encounter and the NDC information configured for the procedure code in the fee schedule, a message appears. Review the information to make sure that you submit the claim correctly.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click edit procedure fees for any fee schedules containing J drug codes.
   The Procedure Fees page appears.
3. Procedure code lookup — Enter J and click Filter.
   The list of J drug codes appears.

For each J drug code listed in the CPT column

4. Click update.
   Additional fields appear.

Under the NDC Information heading

5. NDC Number — Enter the NDC number for this J drug code. You can find the NDC number on the drug label, or you can use the Code and Knowledge Base to find it.
   When you enter a valid number in the NDC Number field, athenaOne displays the corresponding athenaCodesource trade name to the right of the field. Verify that the NDC number entered is correct for the procedure code.
   Note: NDC is an 11-digit number with the format "xxxxx-xxxx-xx." If one segment is not formatted correctly, add a leading "0" to that segment (for example, 12345-123-12 becomes 12345-0123-12). For more information, see NDC number formatting.
   
6. Unit price — Enter the unit price that your practice paid for this drug.
7. Dosage — Enter the total amount dispensed, and select the unit of measurement for this drug.
   Note: You can edit the dosage information on the claim at charge entry time and from the Claim Edit page.
8. Click Save.
   A dialog box appears warning you that this NDC will overwrite any previous NDC for this procedure code in all of your practice's fee schedules.
9. Click OK.
10. To see your changes, display the Fee Schedules page, click edit procedure fees for the fee schedule that you just updated, enter J in the Procedure code lookup field, and click Filter.
    See also: NDC Numbers.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Locate the schedule in the list below.
3. Click the delete link.
   A warning message appears.
4. Click OK to delete the fee schedule, or click Cancel to preserve it.
   
   Note: Deleted schedules appear "grayed out" in the list. To restore a deleted schedule, click the undelete link.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click the edit procedure fees link for the procedure fee that you want to remove from the schedule.
   The Procedure Fees page appears.
3. Look at the heading at the top of the page to verify the payer and name for this schedule.
   If you are viewing the wrong schedule, click the Fee Schedules link in the Task Bar.
4. Enter the CPT code or exact description in the lookup fields for procedure codes and descriptions, and then click Filter, or click Show All to display the complete list of procedure codes in the schedule, and then locate the procedure code in the list.
5. Click the remove link.
   Warning! Do not click the delete link. A warning message appears.
6. Click OK to remove the procedure code, or click Cancel to keep it.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click the edit procedure fees link for the fee schedule that you want to update.
   The Procedure Fees page appears.
3. Enter the CPT code or exact description in the lookup fields for procedure codes and descriptions, then click Filter, or click Show All to display the complete list of procedure codes in the schedule, then locate the procedure code in the list.
4. Procedure code lookup or Procedure description lookup — Enter the procedure code or exact description and then click Filter, or click Show All to display the complete list of procedure codes in the schedule.
5. Locate the procedure code in the list and click the delete link.
   A warning message appears.
6. Click OK to delete the procedure code, or click Cancel to keep it.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Locate the fee schedule that contains the procedure code that you want to remove from the concurrency calculation, and then click the edit procedure fees link.
   The Procedure Fees page appears.
3. Click the update link for the procedure code that you want to remove from concurrency.
   The details for the procedure code appear.
4. Exclude from concurrency (anesthesia only) — Select this option.
5. Click Save.
   
   Important: "Exclude from concurrency" is a property of the procedure code and not of the individual fee schedule (like the description of the procedure). The Exclude from concurrency value will apply to all services entered with that procedure code.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click edit procedure fees for the fee schedule.
   The Procedure Fees page appears.
3. Procedure code lookup — Enter the CPT code, or click Show All.
   The Practice Procedure Code list appears.  
   The Base Unit Value column shows the updated local base unit value for all related CPT codes. Local base unit values are clearly marked "(local)" next to the base unit value.
   Note: To see all local base unit values for your practice, see the Local Anesthesia Base Unit Values page.

You can create "MISC" procedure codes to bill the patient for miscellaneous services, such as filling out forms, patient education, fees for NSF (bounced) checks, and miscellaneous medical items. For example, you could create a procedure code called "MISCCHART" to bill a patient for making a copy of that patient's chart.

Caution: Any outstanding balance on a charge labeled with a procedure code starting with "MISC" is automatically transferred to the patient, except when the payer is Workers Compensation (reference: claimrule #237). To report on voided charges, we recommend that you use the VOIDCHARGE code instead of creating a MISCVOID or MISCDELETE code.

When you create a MISC procedure code, you can edit all the defaulted fields. If the description and other fields are blank, this indicates that the code is not found in the current version of CPT. Your practice can use "dummy" codes for items that you can't bill for.

Note: In order for the procedure code to be valid at charge entry, it must be listed in the allowable and fee schedule for the payer.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click the edit procedure fees link for the schedule where you want the new code to appear.
   The Procedure Fees page appears.
3. Look at the heading to verify the payer for this schedule. (If you are viewing the wrong schedule, click the Fee Schedules link on the left side of the page.)
4. Click Add New. The Add Procedure Code view appears.
5. CPT/HCPCS code — Enter the name of the procedure code. The name must begin with MISC (use uppercase). athenaOne automatically bills the patient for procedures that begin with MISC, except when the payer is Workers Compensation.
6. Description — Enter a description of the new procedure code.
7. Patient-facing description — When this field is populated, this description overrides the regular procedure code description on patient statements.
8. Amount — Enter the fee for the procedure. This amount is billed to the patient.
9. Click Save.

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules.
2. Locate the allowable schedule that you created based on Medicare.
3. Click the edit procedure fees link to display the Filter Procedure Codes view.
4. Do one of the following:
• Enter the procedure code that you want to override in the Procedure code lookup field, and then click Filter to display the Procedure Fees page, with the selected procedure code.
• Click Show All to display the Procedure Fees page, with the entire list of procedure codes.
5. On the Procedure Fees page, click the override link for the procedure code to update. The add/update view appears.
   Note: If the link is labeled update, it means that the allowable schedule was not created based on Medicare schedules.
6. Edit the allowable amount as needed.
7. Make sure that you update the Acceptable allowable range amounts associated with your new allowable amount.
8. Click Save.
9. After you override a procedure code allowable amount, two links appear.
• The update link allows you to change the allowable amount.
• The remove override link restores the default Medicare-based value.

If you use procedure code modifiers to sort procedure codes into procedure code groups, you must configure the procedure code modifiers as fee-affecting on the Procedure Code Modifiers page; athenaOne recognizes a procedure code-modifier combination only if the modifier is set to Fee affecting = Yes).

For example, if CPT code 99213,25 is assigned to procedure code group A and CPT code 99213,59 is assigned to procedure code group B:

• Modifier 25 and modifier 59 must be configured as fee-affecting on the Procedure Code Modifiers page.
• Each procedure code-modifier combination must be entered in the fee schedule for the correct procedure code group.

Note: If you update a fee schedule after claim creation, an incorrect procedure code group is not retroactively corrected in the claim or in the Transaction Activity and Transaction Aging reports that you can run using the Report Builder.