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Fee Schedules let your practice control the charge that auto-fills when a procedure code is added to a bill in the EHR. Billing staff and practice administrators use them to base rates on a percentage of Medicare, set custom rates per procedure code, and apply different rates for specific providers, payers, or service locations.
Fee Schedules is rolling out to practices in phases. If Fee Schedules does not appear in your Billing Settings yet, your practice is still using the Popular CPT Codes list — see Billing Settings — Service Locations & Procedure Codes for managing that list. Your codes and charges carry over automatically when Fee Schedules is turned on for your practice; there is nothing to migrate.

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What is a fee schedule?

A fee schedule is a set of rates Elation uses to fill the Charge field when you add a procedure code to a bill. Each fee schedule has two parts:
  • A Default Billing Rate — a percentage of the Medicare rate for your selected state and county.
  • Custom Rates — per-procedure-code rates that override the Default Billing Rate.
Your practice always has one Default fee schedule. You can create additional fee schedules and scope them to specific providers, payers, or service locations.

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Setup

Fee Schedules live in the EHR, not in Elation Billing. To open them:
  1. Click your email address at the top of your account, then click Settings.
  2. Under Practice Settings, click Billing.
  3. Scroll to the Fee Schedules section.
Your existing Popular CPT Codes appear in the Custom Rates table along with their charges. On your Default fee schedule, changing one of those charges updates it in your Popular CPT Codes list too. On any other fee schedule, the rate you set applies to that schedule only.
Default Fee Schedule, along with additional fee schedules

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Setting the Default Billing Rate

Setting a default billing rate on a Fee Schedule
The Default Billing Rate calculates charges as a percentage of the Medicare rate for a procedure code.
  1. In the Fee Schedules list, click Edit on the fee schedule you want to change.
  2. In the Default Billing Rate section, enter a Percentage. For example, enter 150 to charge 150% of the Medicare rate.
  3. Select a Medicare state.
  4. Select a Medicare county. You must select a state before the county list becomes available.
  5. Click Save.
A fee schedule cannot be activated until both a Medicare state and county are selected. If either is missing, Elation displays Select a Medicare state and county before activating.
Medicare rates vary by state and county. Elation uses the state and county on the fee schedule — not the service location address — to look up the Medicare rate.

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Managing custom rates

Managing custom rates in a Fee Schedule
Custom Rates override the Default Billing Rate for individual procedure codes. Click the Manage rates button to view the Custom Rates table. The Custom Rates table shows:

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Edit a custom rate

  1. Click the Custom Rate ($) field on the row you want to change.
  2. Enter the amount.
  3. Click Save on the row, then Save on the fee schedule.
Save or cancel an in-progress custom rate row before saving the fee schedule. Elation blocks the save until the row is resolved.

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Add a code that is not in the list

You can add a rate for any code, including custom codes your practice created for services without a standard CPT code.
  1. Click Add at the bottom of the Custom Rates table.
  2. Enter the Code — for example, 99999, or a practice-specific code such as FORMS.
  3. Optionally enter a Modifier of up to two characters, for example 26. A code with a modifier is priced separately from the same code without one, so you can charge different amounts for each.
  4. Enter a Description.
  5. Enter the Custom Rate ($).
  6. Click Save.
Adding a code here prices it for this fee schedule. It does not add the code to your Popular CPT Codes list, so it will not appear in the procedure code picker — type the code on the bill as usual.

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Codes in the billing window

The procedure code picker in the billing window still comes from your practice’s Popular CPT Codes list. The Custom Rates table on your Default fee schedule is where you now edit and remove those entries:
  • Changing the charge on a code that is priced by your Popular CPT Codes list updates that charge.
  • Deleting a code on the Default fee schedule removes it from your Popular CPT Codes list and from every procedure code picker.
  • The order codes appear in the picker comes from your Popular CPT Codes list. Fee Schedules has no reordering control, so that order cannot be changed.

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Find a code

Use Search by procedure code, modifier, or description above the table to filter the list. Four checkboxes narrow it further:
  • Custom rates only — codes this fee schedule prices itself.
  • No Medicare rate — codes Medicare publishes no rate for. Use this to find the codes that need a custom rate.
  • Legacy CPT codes only — codes from your practice’s Popular CPT Codes list.
  • Priced by default schedule — codes that take their rate from the Default fee schedule rather than from this one.
Custom rates only does not include rates inherited from the Default fee schedule. To see those, use Priced by default schedule instead.
The Custom Rates table is paginated, so browser search (Ctrl+F or Cmd+F) only finds codes on the page you are viewing. Use the search field instead.

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Delete or export rates

Select rows with the checkboxes, or use Select all rates to take everything your filters currently show. The count above the table tells you how many of the selected rows can be deleted. Then:
  • Delete removes the selected rates.
  • Export downloads the rates your filters currently show, so you can review or edit them in a spreadsheet.
  • Import CSV loads codes and rates from a file. See Import rates from a spreadsheet.
What Delete removes depends on which fee schedule you are in, and neither action can be undone:
  • On an additional fee schedule, codes priced by the Default fee schedule fall back to that price.
  • On the Default fee schedule, procedure codes priced in your Popular CPT Codes list are removed from there and from every procedure code picker.
Elation shows which case applies before you confirm.

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Import rates from a spreadsheet

Import a CSV to set many rates at once — for example, loading a payer’s negotiated rates, or a fee schedule your practice already keeps in a spreadsheet. Your file needs one row per procedure code, with a column of codes and a column of amounts.
Import a CSV file to update a Fee Schedule
1

Open the import dialog

Click Manage rates, then click Import CSV. The Import Custom Rates dialog opens.
2

Choose your file

Click Choose file… and select your CSV. Elation reads the file and shows how many rows it found.
3

Map your columns

Tell Elation which of your columns is which: CPT Code column (required), Amount column (required), Modifier column (optional), and Description column (optional). Your column headings do not need to match Elation’s names. Click Next.
Mapping columns when importing a CSV for a Fee Schedule
4

Choose how the import applies

Leave both checkboxes clear to merge the file into the rates you already have. Select Replace all existing custom rates (instead of merging) to clear this fee schedule’s current custom rates first, or Remove custom rates not in this import to delete the rates for any code your file does not list.
5

Import

Click Import. If you chose to remove rates, the button reads Yes, remove and import instead, and that removal cannot be undone from this screen.
A few things to know before you import:
  • A file can hold up to 10,000 rows. Split a larger file into batches and import each one separately.
  • Elation checks every row before it writes anything, so a file with an error imports nothing rather than importing part of the way.
  • If the same code and modifier appear on more than one row, only one rate is kept.
  • An empty amount means “no rate given.” It does not clear a rate the code already has. To charge nothing for a procedure, enter 0.
  • Importing sets rates on this fee schedule only. It does not add codes to your Popular CPT Codes list, so imported codes do not appear in the procedure code picker.

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Creating additional fee schedules

Create a second fee schedule when part of your practice bills at different rates — for example, one provider with a separate contract, or a payer with negotiated rates.
  1. In the Fee Schedules section, click + Add Fee Schedule.
  2. Enter a Name, then click Save.
  3. Set the scope for each of the three filter sections. Each section defaults to applying to everything:
    Specifying scope of a Fee Schedule
    • Providers — keep Use this fee schedule for all providers, or click + Add Provider or + Add User Group to limit it.
    • Payers — keep Use this fee schedule for all payers, or click + Add Payer and search for an insurance company.
    • Service Locations — keep Use this fee schedule for all service locations, or click + Add Service Locations.
  4. Set the Default Billing Rate and any Custom Rates.
  5. Click Save, then click Activate.
The Default fee schedule applies to all encounters and cannot be restricted by provider, payer, or service location. Only additional fee schedules can be scoped.
Custom rates on the Default fee schedule apply to every fee schedule. Custom rates on an additional fee schedule apply only when that schedule is the one matched to the bill.

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Activating and deactivating

A new fee schedule is inactive until you click Activate. An inactive schedule displays This fee schedule is inactive and won’t be used to resolve claims and is never matched to a bill. Click Deactivate to take a schedule out of use without deleting it.
The Default fee schedule cannot be deactivated or deleted. Every bill that matches no other fee schedule falls back to it, so it has to stay active. If you try to deactivate it, Elation shows a message suggesting you make another fee schedule the default first — but there is no way to do that. Treat the Default fee schedule as permanent.
If two active fee schedules would match the same encounters, Elation displays: These criteria already match fee schedule “[name]”. You can save, but this schedule cannot be activated until the conflict is resolved. Narrow the filters on one of the two schedules, then activate.

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How Elation picks a fee schedule

When you open a bill, Elation matches a fee schedule to it using the provider, payer, and service location on that bill. An empty filter section matches any value. Filters are weighted, and the highest-weighted match wins:
Weighting means a schedule that filters on provider alone outranks a schedule that filters on payer and service location combined (4 versus 3). Check the weights before assuming the more narrowly targeted schedule wins.
If no fee schedule matches, Elation uses the Default fee schedule. Click the info icon next to a fee schedule’s name to see this explanation in the product.
A provider filter matches whether you targeted the provider directly or through a user group — both carry the same weight of 4. If a provider is later added to or removed from a user group, two active schedules can end up tied. Elation then uses the most recently created schedule. Review your schedules after changing user group membership.

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Which rate is used for a procedure code

When you type a procedure code into a bill, Elation resolves the charge in this order and uses the first one it finds:
  1. Custom rate with a Source of Manual — a rate your practice entered in the EHR.
  2. Elation Billing custom fee — a custom fee configured in your Elation Billing account.
  3. Calculated custom rate — the negotiated rate on the custom rate row, multiplied by the Default Billing Rate percentage.
  4. Medicare rate for the selected state and county, multiplied by the Default Billing Rate percentage.
If none of these produce a value, the Charge field is left empty for you to fill in manually.
An Elation Billing custom fee takes precedence over a calculated rate in the EHR. If a charge auto-fills at an unexpected amount, check your Elation Billing custom fees before adjusting the Default Billing Rate percentage.
Exception: This order applies to charges that fill in as you type a procedure code. Service lines that Elation adds for you — for example when a visit note template applies a procedure — skip step 2 and price from the calculated or Medicare rate instead. All-in-One practices that rely on Elation Billing custom fees can therefore see a different charge on an automatically added service line than on one entered by hand. Review the Charge on service lines you did not enter yourself before signing the visit note.

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Fee schedules on a bill

Rates apply automatically as you enter procedure codes in the bill in the EHR:
  • When you add a procedure code, the Charge field fills with the resolved rate. You can overwrite it — a charge you type is always kept.
  • The bill header shows a View fee schedule link that opens the fee schedule Elation matched to that bill. The link does not appear when no fee schedule matched.
    Viewing a Fee Schedule from the Bill Dialog
Fee schedules resolve in the EHR only. The charges on the bill are what Elation Billing uses. An Elation Billing fee schedule only fills a charge on a claim line that is still empty when the claim is submitted.

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Elation EHR + Billing practices (All-in-One)

For All-in-One practices, Elation pulls your existing Elation Billing configuration into the EHR fee schedule:
  • Your Elation Billing Medicare base rate and region settings pre-populate the Default Billing Rate.
  • Your Elation Billing custom fees appear in the Custom Rates table with a Source of Elation Billing.
This is a one-way read from Elation Billing into the EHR. Changing a rate in the EHR does not write back to Elation Billing.

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Frequently Asked Questions

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Can I upload a fee schedule from a spreadsheet?

Yes. Your file needs a column of CPT codes and a column of amounts. Description and modifier columns are optional, and your column headings do not need to match Elation’s names. See Import rates from a spreadsheet for the steps.

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Can I set a separate fee schedule for cash-paying patients?

Not directly. Fee schedules match on the payer on the bill, and self-pay patients have no payer to filter on. Elation is evaluating letting users select a fee schedule manually on a bill. As a workaround, overwrite the Charge field on the bill for cash-paying patients.

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Why does a lab or drug code show “No Medicare rate”?

Medicare publishes lab and drug rates in separate fee schedules from physician procedure codes. Elation’s Medicare rate lookup does not currently include the full Clinical Laboratory Fee Schedule, so some lab and drug codes have no Medicare rate to calculate from. Set a custom rate for those codes. Your Popular CPT Codes list still exists, and its charges are still used when a fee schedule has no rate of its own for a code. Fee Schedules shows those codes in the Custom Rates table, and a Custom Rate you set there is used instead. Manage rates from Fee Schedules so you also get Medicare-based rates and per-payer scoping.

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Does the charge apply to patient invoices?

Yes. Charges that auto-fill on the bill flow through to patient invoices when Invoicing is turned on. See Patient Invoicing. *CPT copyright 1995 - 2022 American Medical Association. All rights reserved.