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US Insurance Setup 2: Assign Rates to Your CPT Codes

  1. Insurance Billing Training (US)
  2. US Insurance Setup 2: Assign Rates to Your CPT Codes

    3. 8 min read
    Practice Plan Thrive Plan

Welcome back to the Jane US Insurance Billing training! This lesson is the second of three steps required to get your account ready to use Jane’s insurance features:

Set Up Task Task Complete
Adding Your Insurers 🥳
Assign Rates to Your CPT Codes ✍️
Location & Staff Billing Info ☐

In this lesson, you’ll assign rates to your CPT codes (the procedure codes you bill insurers for services). Each code needs a billed amount before you can submit a claim.


Instructions

Here’s how to assign rates to your CPT codes in Jane. You’ll also learn what each field means, how to set up favorite codes, and how to add custom billing codes.

Assigning Rates to a CPT Code

By default, Jane opts you into its library of CPT code sets (procedure codes) and ICD-10 code sets (diagnosis codes).

  1. Go to Settings > Billing Codes.
  2. Scroll down to the list of codes at the bottom of the page.
  3. Use the Search field to find a CPT code you use.
  4. Click Assign Rate in the Rate column next to the code. The New Billing Code form opens with the code and label already filled in.

The New Billing Code form with the code and label filled in, showing Billed Amount, Modifiers, and Allowed Amount boxes for the Default row and each insurer

  1. In the Default row, enter the amount to bill for one unit of the CPT code in the Billed Amount box.
  2. Enter any applicable default modifiers in the Modifiers box.
  3. Enter the Allowed Amount for the CPT code in the Allowed Amount box. For a contracted rate with a specific insurer, enter the amount in that insurer’s row. The Allowed Amount stays in Jane and isn’t sent to the insurer on the claim.
  4. Click Create Billing Code to save this new code to your list.

Repeat these steps for each CPT code you bill at your clinic.

Default and Insurer-Specific Boxes

The New Billing Code form includes a Default row and a separate row for each insurer set up in Jane. The Billed Amount field appears only in the Default row, while the Modifiers and Allowed Amount fields appear in both the Default row and each insurer’s row.

Jane uses the Default row when an insurer’s field is empty. If an insurer’s field contains a value, Jane uses that value instead. Use insurer-specific fields when an insurer has different requirements for the same procedure code.

The Default row and the insurer rows with Billed Amount, Modifiers, and Allowed Amount columns on the New Billing Code form

Billed Amount

The billed amount is the full fee for one unit of the CPT code. Jane attaches this fee to the billing code, displays it on invoices, and submits it to the insurer on the claim.

You can create a billing code without a billed amount, but setting one ensures the fee is attached to the code. The Billed Amount field appears once per CPT code, so the amount remains consistent regardless of the insurer being billed.

Modifiers

Default modifiers apply automatically when you add a billing code to a visit. Each modifier is two characters. To assign multiple modifiers, separate each modifier with a space.

Allowed Amount

An Allowed Amount, also called a contract rate or fee schedule, is the price an insurer allows for a CPT code. Allowed Amounts are optional, and Jane does not send them to the insurer on claims.

When you add an insurance policy to a visit, Jane uses the Allowed Amount to calculate the invoice, including the patient’s coinsurance, and to show the amount you expect to collect in A/R. If you leave the Allowed Amount field blank, Jane uses the Billed Amount instead, which may cause A/R to show more than the insurer will pay.

Setting Up Favourite Codes

To save time, you can mark frequently used codes as favourites.

  1. Go to Settings > Billing Codes.
  2. Scroll down to the list of codes at the bottom of the page.
  3. Use the Search field to find a code you use often. You can search by condition name or code.
  4. Click the star icon in the Favourite column next to the code.

🩵 Jane Tip: To see only your favourite codes, click the star button at the top of the list, next to the filters.

The list of codes at the bottom of the Billing Codes page, with the Search field, filters, star button, Assign Rate links, and star buttons in the Favorite column

Adding Custom Billing Codes

If a CPT or diagnosis code isn’t in Jane’s library, add a custom billing code so you can bill insurance with it. Go to Settings > Billing Codes and click New Billing Code in the top right corner. For field-by-field details, see our guide on Creating Billing Codes (US).

What to Expect

After you click Create Billing Code, the code is saved to your clinic’s list of billing codes at the top of the Billing Codes page.

Favorite codes are available for quick access when you add billing codes to a claim. Press the space bar on your keyboard to show them.

🩵 Jane Tip: Once you’ve set up your billing codes, you can limit visit searches to your own fees and custom codes. Go to Settings > Billing Codes, scroll below your clinic’s codes to the Code Sets section, and deselect the CPT code set checkbox. Visit searches will then show only your fees and custom codes instead of the full CPT library.

Important Notes

  • Custom codes you create also appear as favorites in Jane.

Nice work! Only one more setup step to go.

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