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Set up a fee schedule

Create a fee schedule when you use the Custom fee schedule payment model. This is relevant when either

  1. A payor reimburses a billing provider (facility) using their own custom rates
  2. A facility reimburses your therapy organization using their own custom rates

Fee schedules exist within your organization's fee schedule library. You can reference them when you set up a payor arrangement or a facility contract.

Before you start​

You need admin access and the effective CPT rates you want to use.

Medicare's Physician Fee Schedule (MPFS)

You do not need to create a custom fee schedule when reimbursement follows Medicare's Physician Fee Schedule. Instead, select Medicare Part B MPFS as the payment model. RehabAlpha uses CMS Medicare Physician Fee Schedule data for that model.

Understand fee schedules​

A fee schedule is a table of one or more CPT rate periods. For example,

Start dateEnd dateCPT codeRate
—Dec. 31, 202497110$28.00
Jan. 1, 2025Dec. 31, 202597110$30.00
Jan. 1, 2026—97110$32.00
Jan. 1, 2025—97530$35.00
——97112$27.00

Every row is uniquely defined by a date range and a CPT code.

The same CPT code can appear multiple times in the table, but its respective date ranges must never overlap.

RehabAlpha uses the rate for the CPT code that is effective on the service date when it calculates custom-fee-schedule reimbursement.

Set open-ended rate periods

Leave the start date blank when the rate applies to all earlier dates. Leave the end date blank when it continues indefinitely.

Assistant modifications​

For PT and OT services with a CO or CQ assistant modifier, choose an assistant service-rate policy for the entire fee schedule. Your selection determines which additional fields appear in the fee schedule:

Assistant rate policyHow RehabAlpha calculates the assistant rateWhat changes in the form
Use therapist ratesUses the full CPT rate. A $40.00 therapist rate is a $40.00 assistant rate.No changes.
Apply a percentage of therapist ratesApplies one percentage to every CPT rate. For example, 85% of a $40.00 therapist rate is $34.00.An Assistant rate percentage field appears. Enter 0% through 100%
Set CPT-specific assistant ratesUses the rate entered for each CPT code and effective date.A required Assistant rate column appears in the Rates table. It cannot exceed the therapist rate.

Create a fee schedule​

  1. In the sidebar, click Fee Schedules.
  2. Click New fee schedule.
  3. In Basic details, enter a Name.
  4. Under Assistant service rates, choose how to price PT and OT services with a CO or CQ assistant modifier:
    • Use therapist rates uses the same rate for assistant and therapist services.
    • Apply a percentage of therapist rates uses the percentage you enter for assistant services.
    • Set CPT-specific assistant rates adds an Assistant rate for each CPT rate period.
  5. Under Rates, click Add fee schedule value. To add multiple rates at once, paste columns for start date, end date, CPT code, and rate from a spreadsheet. When using CPT-specific assistant rates, include the assistant rate column after the rate column.
  6. For each rate, enter the Start date, CPT code, and Rate. When using CPT-specific assistant rates, also enter the Assistant rate. Enter an End date when the rate has a known end date; otherwise, leave it blank.
  7. Click Save.

RehabAlpha opens the new fee schedule after it is saved.