How to Price Your NEW Evaluation CPT Codes

Please note that this article contains information that is only relevant to American clinics.


With the unveiling of the new CPT codes for evaluations, healthcare providers across America have had to educate themselves on their uses. These new codes have been created specifically for PTs, OTs, and SLPs–and each of them speaks to a specific complexity level. Naturally, the more complex an evaluation, the more time it will take to complete, and the more money your clinic can charge for it. But is pricing your CPT codes really that simple? In this article, we’ll be discussing how to price your evaluation CPT codes.


Click here to read about 2017’s new CPT codes for evaluations.


Overhead expenses


Running a business is really expensive. For starters, you have to pay rent and utilities for your workspace. Then you have to pay your staff to handle your clients and the various products in services that they need to perform their job to the best of their ability. And then on top of that, you have to pay for malpractice insurance. All of this begins to add up pretty quickly and these overhead expenses must be considered when pricing your new evaluation CPT codes.


Profit margin


When pricing your new CPT codes for evaluations, you must also consider your profit margin. Your clinic needs to do more than just break even. That said, you need to take some time to figure out how much money it’ll take to get you to the next level. After figuring out how much money it takes to keep the lights on at your facility, use that number to help you calculate your profit margin.


Complexity levels


The final consideration we’ll be discussing in this articles are complexity levels. As noted in previous blog posts, complexity levels add a whole new dimension to evaluations.


Click here to read about the new evaluation CPT codes and complexity levels.


Logic dictates that a low complexity evaluation will take significantly less time to complete than a high complexity evaluation. Knowing this, your clinic should base the amount of money you charge for an evaluation on the case’s complexity as they’re directly related.


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