How to change CPT codes for a payer

Here are the steps to make the changes in the system if your payer decides to change your current CPT codes. For example, let's say a payer was transitioning from using H2019 to 97153. 

1. First, make sure that you have added the new codes (i.e., 97153) and modifiers (if applicable) to Masters --> Service Codes. If you've been using 97153 for another payer you can skip this step. 
2. You will need to make new activities for the new codes. You can make a new activity in "Masters --> Appointment Types". You should already have a "Direct Behavior Therapy" appointment type in the system. We created a second one called "Direct Behavior Therapy (Use After 3.30.20)" as an example. You can modify the name as needed.
   1. 
3. Go to Manage Payers
4. Select the appropriate payer and go to "Payer Service Codes"
5. Add the new service code (i.e., 97153) to the payer service codes areas with necessary rates and modifiers. 
6. Go to Payer Activity and then click on Add Activity
7. Add the new activity "Direct Behavior Therapy (Use After 3.30.19)" and then add the 97153 CPT code with any modifiers.
8. You're now done with adding a new code to the payer. Instruct your staff to use this activity based on the date the payer has made the change. 

Authorization Changes:

1. If the payer issues new authorizations due to the new codes, please make sure to delete all recurring appointments on and after the start date of the new auth. You will have to reschedule appointments with the new auth. 
2. If the payer doesn't issue a new auth, they should give you a date as to when to use the new codes. We highly recommend splitting the authorizations by code. For example:
   1. Payer says you will need to use 97153 as of 4.1. You have an auth that goes from 1.1.20 - 6.1.20.
   2. Split the auth so that the old codes go from 1.1.20 - 3.31.20 and another auth (with new codes) go from 4.1.20 - 6.1.20.
   3. This will prevent your staff from using the old CPT codes after the payer is no longer accepting the old codes.

Once you've collected all the payments for the old code, please email support so we can delete the old code and activity from the system. If you have any questions regarding transitioning CPT codes, please email support!