How to add CPT codes and Activities

Adding CPT Codes

• Go to Masters --> Service Codes. Click on "Add Service Code"
• All this information can be changed at the payer level (rate, duration, rounding rule, modifiers). We will use 97153 (15 minute unit) as an example. 
  • Service code (i.e., 97153)
  • Rounding rule (i.e., 15 minutes). This information is given to you by the payer. Theralytics uses CMS rounding rules in the system. If the payer uses a rounding rule that differs from the standard CMS rounding rules then please send an email to support for further assistance.
  • Unit duration (i.e., 15)
  • Unit type (i.e., minutes)
  • Rate per unit - If you use your own fee schedule then you would want to make sure you add your fee schedule rate here. If you don't have your own schedule, you would create your own fee schedule here OR use rates from one of your contracts. Rates can be changed at the payer level so if you bill contracted rates you can choose o. 
  • Modifiers: Add all possible modifiers that you use for this service code (i.e, HM, HO) and the corresponding rate right next to it. Press the green "plus" sign to add additional modifiers. Only add one modifier per line. 
  • Description: Add a brief description of the CPT code.
  • Select whether the code is billable and requires an authorization
• Once you added your CPT code you will then need to add a corresponding appointment type.

Adding Appointment Types

Appointment types are labels for service codes that you would use in the system. Examples:

• Direct Therapy by RBT
• Program Modification by BCBA
• Parent Training by BCaBA. 
• Telehealth Parent Training by BCBA

Appointment types can be further defined by the payer. For example, Direct Therapy by RBT for BCBS might be 97153-HM. Direct Therapy by RBT for Medicaid might be H2019. Appointment types allow you to use the same labels across the system even though the CPT code across payers may differ.

• Go to Masters ---> Appointment Types. Click on "Add Appointment Type"

• You'll need to add the following:
  • Appointment Name: We recommend titling the appointment type by the name of the service as well as who will perform the service. Separating by the level of practitioners (i.e., RBT vs BCBA) is required if you use modifiers. 
  • Default Duration: This is no longer used in the application, but you can enter a value that corresponds with the unit length.
  • Color: Background color of the appointment on the scheduler
  • Font color: Font color of the appointment type on the scheduler. 
  • Therapy: Type of therapy you want to associate the appointment type with (ABA therapy, Speech Therapy, Occupational Therapy..etc). ABA Therapy would be listed by default.
  • Description: Enter a brief description of the appointment type (optional)
  • Billable: If the appointment type will be attached to a CPT code then this box will need to be checked
  • Client Required: If the appointment type will be attached to a CPT code then this box will need to be checked
  • Include in RBT Supervision: Only check this option if the appointment type will be used by an RBT. This allows Theralytics to generate RBT supervision reports.
  • Allow overlapping: Checking this box allows one therapist to be scheduled across more than one client (i.e., group services).