CPT/HCPCS Clause Samples
The CPT/HCPCS clause defines the use of standardized medical coding systems—Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)—for identifying and billing medical procedures and services. In practice, this clause requires that all services rendered under the agreement be reported using these codes, ensuring consistency in claims submission and reimbursement processes. By mandating the use of CPT and HCPCS codes, the clause promotes uniformity, reduces billing errors, and facilitates accurate communication between healthcare providers and payers.
CPT/HCPCS. United routinely updates its fee schedule in response to additions, deletions, and changes to CPT codes by the American Medical Association; HCPCS codes by the Centers for Medicaid and Medicare Services; and in response to similar changes (additions and revisions) to other service coding and reporting conventions that are widely used in the health care industry. Ordinarily, United’s fee schedule is updated using the original construction methodology along with the then-current RVU of the published CPT code. United is committed to providing transparency related to our fee schedules. If you have questions about this fee schedule, please contact Network Management at the address and phone number on your network participation agreement or you may use our fee schedule look-up function on the web at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ or contact our Voice Enabled Telephonic Self Service line at (▇▇▇) ▇▇▇-▇▇▇▇. Last Routine Maintenance Update: 10-01-2007 Default Percent of Charges: [***] Anesthesia Conversion Factor: [***] Anesthesia Rounding Option: [***] Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technical modifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under the customer’s benefit contract will be subtracted from the listed amount in determining the amount to be paid by the payer. The actual payment amount is also subject to matters described in this agreement, such as the payment policies. Please remember that this information is subject to the confidentiality provisions of this agreement. * Note: Maintenance to this fee schedule occurs routinely and may still occur after the report date for the fee amounts selected. Confidential and Proprietary Not for Distribution to Third Parties * Confidential Treatment Requested by Celera Corporation*