🧮 CPT Calculator (Medicare-Correct)
Built-in CPT code calculator that catches the Medicare 8-minute rule + remainder rollover most practices miss. Real underbilling fix shipped 2026 — this is one of the highest-impact billing tools in the platform.
⚠️ Why It Matters
Most practice-management tools implement the 8-minute rule but miss the remainder-rollover rule that Medicare specifically requires. Result: practices systematically under-code time-based services, leaving real revenue on the table.
Synalux’s CPT calculator implements both:
- 8-minute rule — minimum 8 minutes of one-on-one time per billable unit of time-based codes (97530, 97110, 97140, etc.).
- Remainder rollover — when the total minutes spans multiple service types, leftover minutes from one service can roll over to fill the 8-minute floor of another. Most software doesn’t compute this.
🧪 Worked Example
Session has:
- 23 minutes of therapeutic exercise (97110)
- 12 minutes of manual therapy (97140)
- 3 minutes of neuromuscular re-education (97112)
Naive calculation: 97110=2 units, 97140=1 unit, 97112=0 units → 3 units billed.
Synalux’s correct calculation: rollover the 3-min orphan to a service that qualifies → 3 units, with the third unit allocated to the highest-RVU service (97110). Same total but billed correctly per Medicare guidance.
For a practice doing 1000 sessions/month, this fix typically recovers 4-8% of billable time = 5-figure annual revenue restoration.
🏗️ Architecture
services/cpt-calculator.ts— pure function; no I/O.POST /api/v1/billing/cpt-calculate— server endpoint that takes session minutes + service breakdown, returns the unit allocation with explanation.- Drives the SOAP note’s billing block + the Billing & Insurance charge entry.
⚖️ Compliance
- Audit log captures every calculation with input + output + timestamp — defensible if questioned by an audit.
- Configuration locked to Medicare’s published rules; can’t be overridden per-workspace (intentional — wrong overrides cause fraud risk).
💳 Plans
Available on Standard+.