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Different Rates for the Same CPT Code Question

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14 comments

  • Denise Ibrahim, MS, CRC, LMHCA

    I have the same question, so I hope someone gets back with an answer to this question.   In my case though, it is not a different clinician, it is the same clinician but when using a more complicated modality, charges more money.

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  • Lori K. Roberto

    I have this same question. In my case, some of my longer term clients are at an older rate, while newer clients pay my current rate. Why can't there be more than one rate per CPT code?

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  • Tori Reap

    Lori,

    We have just run into that problem as well. One of our new clinicians is keeping her old clients at a $150 rate and the new clients at a rate of $180. I have to manually go in and change the rate depending on the status of the client. I wish there was some type of modifier or way you could include it in the name of the service which clinician and what rate the CPT code is for.

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  • Carin Goldstein

    Hey all...I've run into the same problem as well...has anyone found info that helps?

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  • Tori Reap

    Carin,

    No. I have not received any answers on this or helpful info.

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  • Laelia Gilborn

    Similar issue: I see kids for 45 minutes, and adults for 50 minutes.  The fees are different. The both fall within 90834.

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  • Deborah Beriro

    Same issue! Has anyone reached out to their customer care team?

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  • Denise Ibrahim, MS, CRC, LMHCA

    I commented above and have since found/created something to help me that I'll pass on until we hear from SP or a change of improvement has been made.   

    I added a "letter" after the code to tell the difference between codes.  I charge one amount for therapy code "90837".  When I use a more complicated modality that I'm trained in, I use a code I created that I labeled "90837L".   I would think this would be easy to also use between different clinicians in the same clinic by added their initial after the code.   

     

    This is how I created that code:   

    I went to "My account" in far right hand corner, then clicked on "settings".  After getting into settings, on the left side of the page I went to "Billing and Services".    I then clicked on "services" and then clicked the button "add a new service".  This is where I created my 90837L service with the different price code.  You might even be able to add a dash to the code so it would look like 90837-L

    I don't use the billing services through SP so don't know if that would mess up the billing, but I have found this works for me for being able to use the same code but charging different rates. It also helps me separate the differences between which therapy modality I used.   Hope this helps.

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  • Stephanie A. Cook (Director, Marathons and Workshops Only)

    Denise you are brilliant thank you. Hope SP gets on this one ASAP to make it easier. But great "hack"!

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  • Ruth

    Hi Everyone - Thank you all for sharing your feedback and workflows on this topic! 

    Denise - You've come up with a great solution for self-pay appointments. However, if you're billing insurance, then these adjusted service codes won't be recognized as billable by the payer. Another option is to change the Default Service Code fees for clients seeing these clinicians. To do this, click Edit in the client's file > Billing and Insurance, scroll down to add Default Service Codes and adjust the fees accordingly. 

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  • Samuel P. Bryant

    Hi Ruth, 

    Has there been any update? Going into every clients file and adjusting the fee's one by one is seriously a hassle for any practice with a large amount of clients or a large amount of clinicians for that matter. Please update us if there is any better solution. Very much in need of this. 

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  • Ruth

    Hi Samuel, can you please add your comments and vote on this feature request, here: https://simplepractice.uservoice.com/forums/918553-simplepractice-feedback/suggestions/39796915-in-group-practices-allow-for-the-same-cpt-code-to ? Thank you for your feedback, our Product Team often uses posts made on our Ideas and Suggestions Board to inform future enhancements! 

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  • Melissa Jones

    Hello

    I am a SLP who had the same issue.  Support told me to do this to set it up on each client as a default. Go to the client's Overview page > Edit > Billing and Insurance, then scroll to the bottom of the page and change the fee to whatever you want it to default and then it will show that everytime and you don't have to change it.

    Hope this helps! 

    Melissa 

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  • Marie R. Paddock

    This discussion was helpful.  I am setting up SP to transfer from another EHR (TNest).  I was having difficulty accommodating all the different insurance company rates on CPT codes and having different self-pay rates based on clinician licensure/training level.

     

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