And each CPT code has a price attached to it, like a barcode on something in a grocery store.  Just as barcodes let the cashier know how much an item costs, CPTs let medical and insurance providers know the standard price of care.  Imagine each procedure is like a basket.  As you go through the store and put things in your basket it will have more and more barcodes in it.  Likewise, the more involved a patient encounter is, the more CPT codes the visit will have.  Something like a hemoglobin lab will have one CPT code and one fee.  However, an MRI of the Brain with Contrast will have one fee to cover the technical components of the MRI, a second fee for the professional components of the MRI, and a third fee for the Contrast.

So why are CPT codes important to research?  They determine what rates should be charged for project procedures in human subject research when using HCMC resources.  If a hemoglobin analysis is to measure A1c biomarkers (a procedure to determine how at risk for diabetes a patient is), then the Medicare price associated with the CPT code is what you should charge the project sponsor.  This means, if there are human subject procedures, the CMS Medicare prices associated with the CPT code should be looked at when building a project’s budget.

You don’t want to anticipate a procedure to be billed at $35 but realize after the budget is created that it must be billed $50.  The best way to avoid this is to review the protocol and consider what procedures must be done.  Break each of them down into their individual parts and, from there, use CPT codes to determine how much each procedure will cost.

The easiest way to obtain pricing is to go the MMRF’s website, type in “CPT codes” in the search bar and press enter.  Click on the first link and then on the “HCMC 2017 Research Fee Schedule”.   This pdf lists the research codes most commonly used at HCMC and MMRF broken down by their professional and technical costs.  Professional costs are for the staff and personnel involved; technical is for equipment and supplies needed to complete the task.  If a code for your procedure is not on this list, contact the MMRF Research Information Technology office at jbanchor@hhrinstitute.org.

The last thing to do is fill out the HCMC Resource Utilization & Coverage Analysis Checklist.  This form is used to help define resources, coordinate with the appropriate departments, and identify the necessary codes.  To do so, list each billable service beyond the normal standard of care and its corresponding code (if applicable) in the Patient Care, Non-Patient Care, or Data sections of Part I and determine the cost.  Next complete Part II to determine whether the project qualifies for Medicare reimbursement.  Regardless of who is paying for the procedures (Medicare or the sponsor), the Medicare Research Rates will need to be used for budgeting.

This form is located at the end of the IRB application and must be filled out with every new study proposal or protocol revision.  Once received, the MMRF Research IT office will contact you with any questions and to ensure that study personnel who will be responsible for accessing HCMC resources have received the necessary EPIC training.

If you have any questions about CPT codes or anything else feel free to email us at researchinquiry@hhrinstitute.org.  Thanks for watching and have a good day.