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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

Charge Posting

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.

Payment Entry

Roll-Up Billing by CPT4 Code and Transactions