Lookup Tool vs. Code Tool

Either the Procedure Lookup Table tool (Lookup tool) or the Procedure Code Reimbursement tool (Code tool) is required to calculate reimbursement in these scenarios:

• Based on a procedure lookup table and / or fee schedule
• For line-item charges

However, some key differences help identify which tool works best for certain situations. See the following for additional information:

• Procedure Lookup Table

• Procedure Code Reimbursement

The following table summaries the differences in these two tools:

Procedure Lookup Table Tool	Procedure Code Reimbursement Tool
Applies the same reimbursement method (e.g., override amount or multiplier) to all referenced tables.	Can apply a different reimbursement method (e.g., override amount or multiplier) to each referenced table
Does not effectively or consistently reprice modifiers.	Recognizes and reprices modifiers accurately
Can reference multiple code types.	Only references CPT4 and HCPC code types
Can only apply a line-item cap of charges.	Can apply a line-item cap of percent of charges