Fee Schedule

The Fee Schedule tool lets you define a percentage to apply to line items where the expected payment amount is determined from a fee schedule for a specific place of service.

This tool applies the defined percentage to line items with a qualified place of service that have not been repriced by another reimbursement tool, that is, a line item whose resources have not been consumed.

If a line item has a qualifying place of service and has not been repriced, this tool reprices it to the entered percentage of the price in the fee schedule.

The Fee Schedule tool allows you to enter multiple percentage lines and define a fee schedule and place of service (POS) for each percentage. If you enter multiple percentage lines, the lines are calculated from top to bottom.
The place of service filter compares the place of service for the line item to the POS column.
- If the place of service is found, the tool looks for the procedure in the procedure lookup table for that percentage line.
- If the procedure is found in the lookup table, the defined percentage is applied to the base amount in the lookup table.
A procedure code matches an entry in a lookup table according to standard matching rules. For more information, refer to Reimbursement Tools.
If a procedure qualifies for more than one percentage line, the When codes are found in more than one Fee Schedule, pay field determines which lookup table is used. Valid values include Highest Reimbursement, Lowest Reimbursement, and First Occurrence (top-most line of the percentage lines listed in the Fee Schedule tool).
If you select the Consume Resources check box, the units are consumed. If you clear this check box, the resources are not consumed.

Field Descriptions

The following table describes the fields on the Fee Schedule reimbursement tool.

Field	Description
Fee Schedule Percentage	Sets the percent of the base amount in the fee schedule at which the procedure code is reimbursed. For example, if you enter 75, all procedures that match the place of service and have not been repriced by another tool are repriced at 75% of amount listed in the fee schedule.
Of	A drop-down list that lets you select a specific fee schedule.
POS	A drop-down list that lets you select a specific place of service.
+	Clicking the plus (+) adds another percentage line to the tool and lets you define a fee schedule and place of service.
-	Clicking the minus (-) sign removes that percentage line from the reimbursement tool.
When codes are found in more than one Fee Schedule, pay	If a procedure qualifies for more than one percentage line, this field determines which lookup table is used. Valid values include Highest Reimbursement, Lowest Reimbursement, and First Occurrence (top- most line of the percentage lines listed in the Fee Schedule tool).
Consume Resources	Indicates whether units are consumed. Selecting this check box consumes resources. If you do not select this check box, resources are not consumed.