NextGen Knowledge Center

Add or Modify CPT4 Codes for Encounter Rate Billing

Encounter rate billing involves the insertion of an Encounter Rate (ER) code onto the patient's encounter. The ER code can then be included on the claim to the payer. The ER code must first be created as a CPT4 code.

Example ER Codes may include the following:
  • Medicare FQHC: G0466, G0467, G0468, G0469, G0470
  • Medicare RHC: 0521 Clinic Service
  • Medicaid: 0529 Clinic Service
  • Medicaid Texas: T1015 Clinic Service
  • Medi-Cal: 01 Primary, 02 Secondary, 03 Dental, 04 Optometry

To add or modify a CPT4 code for encounter rate billing, do the following:

  1. Access File Maintenance.
  2. Select System Master Files, then PM, and then CPT4 Codes.
    The CPT4 Code Search window opens.
  3. Do one of the following:
    • To add a CPT4 code, select Open Menu and select New.
    • To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open.
    The Add/Modify CPT4 Code Information window opens.
    Add CPT4 Code Information

  4. In the Code field, enter the CPT4 code. This field is required.
  5. In the Description field, enter a descriptive name for the code. This field is required.
  6. In the Type of Service field, select Medical Care.
  7. To save changes and close the window, select OK.