Roll-Up Billing by CPT4 Code and Transactions
The following charges are entered on an example encounter:
| Charge | Alt CPT4 Code | Amount | Preventive/Non-Preventive |
|---|---|---|---|
| 99212 | 0521 | $95.00 | Non-Preventive |
| 11301 | 0521 | $150.00 | Non-Preventive |
| 76090 | $200.00 | Preventive |
When the encounter is billed, a UB/837I claim is created. The appearance of the claim is a result of parameters defined within thePayertab on theService Itemslibrary.
- Claim Line 1:
Includes the CPT4/HCPCS code (0521). The total charge amount is equal to the sum of all services that rolled-up because they have the same Alternate CPT4 Code (0521).
- Claim Lines 2 - n:
Other services are listed separately on the claim with their corresponding CPT4/HCPCS code and charge amount.
The payer remits a $90.00 payment on the 0521 CPT4/HCPCS code line item.
Because the encounter does not include the 0521 line item, the payment must be posted manually against the original charges. Adjustments are also posted manually against the original charges so the appropriate balances, if any, can be settled to secondary insurance or to patient.
