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Using Custom Billing Code for all codes not listed (all remaining codes = CTSM-RM) #463

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narenlulla opened this issue May 2, 2022 Discussed in #419 · 0 comments
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@narenlulla
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Discussed in #419

Originally posted by kgosserand March 24, 2022
We have contractual arrangements where a handful of codes will price with a certain percentage of charge, while other types of codes will price with different percentages of charge. We would like to use the CSTM-00 reporting type to report the remaining sets of code types outside of this handful of codes. For Example: Provider A has X% of charges for 10 J-codes and Y% of charges for all other CPT/HCPCS codes. We would like to individually report the rate (X%) for the 10 J-codes and report Y% for “all other” CPT/HCPCS codes using the CSTM billing code.
When using the CSTM-00 reporting type, can we set the text of the negotiated_price object's "description" attribute to further clarify that the set of codes the percentage of charge applies to is the all possible codes for the specified code type not already listed in the file?

{
"negotiation_arrangement": "ffs",
"name": "CPT Codes",
"billing_code_type": "CPT",
"billing_code": "CSTM-00",
"description": "All CPT codes not otherwise specified in this file",
"negotiated_rates": [{
"provider_groups": [{
"npi": [6666666666],
"tin":{
"type": "npi",
"value": "6666666666"}
}],
"negotiated_prices": [{
"negotiated_type": "percentage",
"negotiated_rate": Y,
"expiration_date": "2022-01-01",
"service_code": ["18", "19", "11"],
"billing_class": "institutional"}]

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