Fee Schedules
How Fee Schedules Work
Billed rate: The amount charged to insurance. You can configure different billed amounts per payer using payer-specific fee schedules.
Allowed rate: The expected payment amount based on your contract. This is for internal tracking only and is not transmitted to the payer. In-network rates are based on your contract; out-of-network rates are estimates.
Fee schedule rates are captured at service creation time. If you update a fee schedule, existing services are not affected — only new services will use the updated rate.
Payer-Specific Fee Schedules
To bill different rates to different payers, create a separate Payer Group for each payer and assign a fee schedule to each group.
Ritten checks the payer-specific fee schedule first. If the CPT code is not found there, it falls back to your default fee schedule.
If the CPT code is not found on either schedule, the billed amount will be $0 — you'll see a warning when attempting to create the claim.
Add-on codes pull rates from the payer-specific fee schedule. If an add-on code is showing $0, check that the CPT code exists in the correct fee schedule. If the configuration looks correct, contact support.
Modifier Fallback Behavior
If a CPT code + modifier combination is not found in the fee schedule, Ritten falls back to the base CPT code entry. To prevent this, add an explicit row for each CPT + modifier combination you need to bill.
Fee Schedule Date Ranges
Fee schedule date ranges are not supported. Annual rate updates must be made manually by updating the fee schedule entries directly.
Missing Rate Notifications
Ritten does not send a notification when it falls back from a payer-specific fee schedule to the default, or when a CPT code is missing entirely. The only visible indicator is a warning at claim creation when the billed amount is $0.
Add-On Codes and Fee Schedules
Add-on codes pull from the payer-specific fee schedule. If you have set a custom flat rate by unchecking "Use Fee Schedule" in Advanced Options, add-on codes will bill at $0. Keep "Use Fee Schedule" checked to apply payer-specific rates to add-on codes.
Self-Pay / Private Pay
Create a dedicated Payer and Payer Group (e.g., "Self Pay") and add it to the relevant service rules.
See the Client Fee Schedules article for setting custom rates or percentage discounts on a per-client basis.