The Financial Category Replacement Code

You can use the Financial Category Replacement Code grid to replace a code if you have a payer that requires a code other than the standard. A few of these are already configured, such as for Electrical Stimulation: when the Financial Category/payer is Medicare, the system replaces the 97014 code with G0283.

This can also be filtered down to a specific payer within a Financial Category to accommodate the need for some clients to have different Revenue Codes for PT vs OT on the claim forms, you can set replacement codes based on the modifier attached to codes (GP or GO modifiers).

This enables you to have one set of codes for PT and a slightly different set for OT, each tied to the correct Revenue code.

When the claim is generated, the actual code can be billed without the modified replacement code showing by setting up the code correctly in your SIM library.