Per Visit Co-Pays

For Patient Insurance Plan Types that require a copay per visit rather than per procedure, follow these steps to set up the plan.

If the office is billing the copay to insurance:

  1. Create a new non-D procedure code called office visit or something similar. See Add Procedure Code.
  2. Set up a copay fee schedule. See Fee Schedules.
  3. If the carrier's fee schedule is normal (in-network), enter the copay as the fee for the procedure code in the UCR fees, the carrier fees, and the new copay fees.
    If the carrier's fee schedule is out of network, enter the copay as the fee for the procedure code in the carrier, the new copay, and the UCR (office fees) fee schedules. In this scenario the office may need to create a different procedure code for each carrier.
  4. On the Insurance Plan, for Patient Co-Pay Amount select the copay fee schedule.
  5. Add the new procedure code (office visit) to each scheduled appointment for any patients with this insurance.

If the office is not billing the copay to insurance:

  1. Create a new non-D procedure code called office visit or something similar. Check the Do Not Usually Bill to Insurance box. See Add Procedure Code.
  2. Enter the per-visit copay amount in the UCR fee schedule.
  3. Add the new procedure code (office visit) to each scheduled appointment for any patients with this insurance.