Procedure Code Defaults

Claim Defaults

CollaborateMD allows you to set claim defaults to any of your procedure codes. Claim defaults can greatly improve your workflow and help you create claim faster by automatically populating information on your claims based on your claim defaults. 

Once changed, the defaults will only take effect for newly created claims. 

Follow the steps below to edit the claim defaults for your procedure codes.

  1. Select Customer Setup > Codes... > Procedure Codes.

  2. Use the Search field to find the procedure code by the CPT/HCPCS code or description. Or use the Show All button to view all codes.

  3. Select the Procedure Code.

  4. Locate and click on Defaults from the right-hand side panel.

  5. Set the following Defaults.

  6. Exclude this code from duplicate service checks.

    1. Check this box to exclude this code from being validated when a duplicate service request is made upon claim creation.

  7. This is an all inclusive code. 
    1. Checking this box means this code covers all other procedures on the claim, therefore, all other line items on the claim are set to PAID.

  8. This code is a percentage of the claim totals.
    1. Checking this box means the code should be calculated as a percentage of the claim total dollar amount. This will also remove the Default Price and Default Units fields, as well as add a Default Percent field, in which to specify to a percentage of the total claim dollar amount this code represents.


    1. Enter the default price and units for this code.
    2. Set the Default Charge Status this code should have when added to a claim.

  9. Rev Code.

    1. Enter the default Rev Code manually or by clicking on the magnifying glass and choosing from the list.

  10. Place of Service.

    1. Enter the default Place of Service for this code manually or by clicking on the magnifying glass and choosing from the list of options. Note: If no default POS code is selected, it will automatically default to POS 11 on the claim.

  11. CLIA Number.

    1. Enter the Clinical Laboratory Improvement Amendment number for this code if applicable.

  12. Type of Service.

    1. Enter  the default Type of Service (TOS) for this code manually by clicking on the magnifying glass and choosing from the list of options.

      If no defaulted TOS code is selected, it will automatically default to TOS 1 (Medical Care) on the claim.


Modifiers (Global & Standard)

    1. Modifiers (Global)If this code has global default modifiers that should be billed with the code a majority of the time, enter them here manually or by clicking the magnifying glass and choosing from the listed options.

    2. Modifiers (Situational): To enter modifiers that should be billed with the code in certain situations, click the Create situational modifiers link to begin entering the modifiers and rules for when these modifiers should be used on the claim.

      Situational based modifiers can be set for Dates of service, Primary Payer, Facility, and Rendering Provider.  Users can add an internal note within the Notes box. 

Drug Information


    1. Enter your default Drug Price & Units if applicable.

    2. Use the Drug Units Measure drop-down menu to select the measurement units for the drug code.

  1. Drug Code. 
    1. Enter the Drug Code for this code. 

  2. Drug Code Format.

    1. Use the Drug Code Format drop-down menu to select the appropriate Drug Code Format.

  3. Additional Description (for non-specific procedure codes). Use this field to write any additional description. 


Effective/Termination Dates



    1.  If your code has Effective and Termination dates, you can enter the dates in manually or choose the dates from the interactive drop-down calendar.

Superbill Options

  1. Print this code on Superbill: Place a check in this box to have the code display on your superbill.

  2. Category: This option shows how the codes are grouped on superbill.

  3. Description: Write an abbreviated description.