AMA CPT Codes vs. Custom Services in MediSprout

1. What They Are

AMA CPT Services (Standard)
Services mapped to a code from the AMA Current Procedural Terminology code set. Examples: 90837, 90847, 90791. These codes are licensed by the AMA and require a paid subscription per provider to use within MediSprout.

Custom Services
Services defined by the organization that do not map to an AMA CPT code. They can have any name, description, and cost — including $0. Introduced to support non-CPT procedures, complimentary sessions, or internal tracking entries.

2. Subscription Requirement

	AMA CPT Services	Custom Services
AMA CPT subscription required	Yes — $20.50/year per provider	No
Subscription tied to provider	Yes — per provider, not per org	N/A

If a provider does not have an active AMA CPT subscription, CPT-coded services are unavailable on their visits and superbill automation is disabled for them.
Custom services are available to all providers regardless of subscription status.
A provider must cancel their AMA subscription before they can be deactivated from the organization.

3. Invoicing Behavior

Both service types can be included in patient invoices via Stripe. Key distinctions:

Custom codes can be invoiced even when the visit provider does not have an AMA subscription.
Custom services with a cost of $0 can be included in invoices using a "free service" checkbox. The backend validates that CPT costs and the invoice total are greater than zero when CPT codes are also present.
Zero-dollar invoices (invoice total = $0) are not supported — there must be at least one paid service in the invoice.
The Create Invoice screen shows only: Service code, Description, Units, Fee. Dx and POS are not fields on the invoice screen — they are visit-level fields relevant to superbill and insurance claims only.

4. Superbill Generation

This is where the behavior difference is most significant.

	AMA CPT Services	Custom Services
Appear on superbill	Yes	Yes (as line items)
Can trigger superbill automation	Yes (if prerequisites met)	No — custom services alone cannot trigger automation
Included in superbill PDF	Yes	No — superbill generation includes only CPT codes, custom procedure codes are excluded (Sprint 126, May 2026)
Require Dx, POS, Units, Fee for automation	Yes	N/A

Prerequisites for superbill automation (all must be met):

Provider has active AMA CPT subscription
Visit is Completed
Visit has at least one CPT code
Each CPT code has: diagnosis (Dx), Place of Service (POS), units, and fee

If any prerequisite is missing, automation fails. The provider can retry or create the superbill manually.

Important: Dx and POS fields on the visit detail page are not required for invoicing — they are only required for superbill generation. These fields can be edited when creating a superbill, including for visits that have already been invoiced. (Sprint 114, Aug 2025)

5. Insurance Claims

	AMA CPT Services	Custom Services
Eligible for insurance claims	Yes	No
Appear in claim procedure list	Yes	No — custom service codes are excluded from the insurance claim procedure list (Sprint 125, Mar 2026)
"Claimable" visit definition	Completed visit with at least one CPT code	Not claimable

The claim creation modal filters out visits that do not include any CPT codes. A visit with only custom services cannot generate an insurance claim.