Arbitration

CPT Code Registry

Vilulia includes a built-in CPT/HCPCS code registry seeded from CMS Physician Fee Schedule Relative Value files. It covers 16,978+ active codes and is used throughout arbitration case forms for code entry, validation, and RVU data. The registry is available to all authenticated users — it is not gated behind the IDR add-on.

What you'll learn

How the code registry is populated and kept current
How to search for codes using the typeahead field
What the AMA license self-certification unlocks
How codes are validated when entered on case forms

Registry data source

The registry is seeded from the CMS PFS Relative Value Files, which CMS publishes quarterly. Each record includes the HCPCS code, status code (Active, Restricted, etc.), work RVU, practice expense RVUs (facility and non-facility), malpractice RVU, total RVUs, conversion factor, and the PFS year. Code descriptions are stored separately and are gated behind AMA license certification (see below).

Vilulia synchronizes the registry with each CMS quarterly release. The PFS year and last-updated timestamp are visible to system administrators.

Searching for codes

Anywhere a CPT or HCPCS code field appears in a case form, Vilulia provides a typeahead search. Type at least two characters to trigger results:

Code-prefix search: Entering digits or an alphanumeric prefix (e.g.,992 or A00) matches codes by prefix.
Description search: Available only to tenants with AMA license certification. Entering a non-numeric term (e.g., office visit) searches both code prefixes and short descriptions.

Results are ordered by code and capped at 20 per query by default (up to 100 with the explicit limit parameter).

AMA license self-certification

CPT code descriptions are copyrighted by the American Medical Association. Displaying descriptions within Vilulia requires a valid AMA CPT license. Tenants that hold such a license can self-certify in the platform:

Navigate to Settings → Features.
Under CPT Registry, toggle AMA CPT License Certification to on.
Confirm the certification. The timestamp and your user ID are recorded against your tenant account.

Only users with the tenant_admin role can enable or disable AMA certification. Once enabled, all users in your organization gain access to description display and description-based search. Disabling the certification immediately removes description access for all users.

By enabling this feature, the tenant admin certifies that the organization holds a current AMA CPT license that covers use of descriptions within case management software. Vilulia does not verify license ownership — responsibility for compliance with AMA terms rests with the tenant.

Code validation in case forms

When CPT codes are entered on arbitration case forms (demand filing, IDR case details, billing dispute fields), Vilulia validates each code against the registry before the form can be submitted. Validation checks:

Existence: The code must be present in the registry.
Active status: Only codes with an Active status code pass validation. Retired or restricted codes are flagged.

Up to 100 codes can be validated in a single batch request. Invalid codes are returned separately with their original values so the submitter can correct them before proceeding.

RVU and payment data

For each valid code, the registry returns work RVU, non-facility and facility practice expense RVUs, malpractice RVU, total RVUs, and the CMS conversion factor for the current PFS year. These values are used by the Medical Billing IDR module to calculate expected Medicare payment amounts and to surface the disputed amount in context. See Medical Billing IDR for details on how RVU data is applied in IDR determinations.

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