A CAP code is a line item in Helia that represents a bundle, kit, or construct — a group of implants billed together at a single capitated price rather than individually. When you see a CAP code on a delivery order, it means the rep has submitted the case under bundled pricing agreed upon in your contract.
What to check when reviewing a case with a CAP code
The CAP code should appear as its own line item alongside the individual implants on the order. The individual items within the bundle will show at $0 — that's expected. The CAP code line item itself carries the full bundled price.
For example, a total joint replacement case might show several individual implant components each at $0, plus a CAP code line item with the total construct price. That's the correct way it should look. If the items and total price look correct against your implant log, you can approve the case as normal.
A total joint replacement case might look like this:
Femoral Component — $0
Tibial Insert — $0
Tibial Tray — $0
Patellar Component — $0
CAP Code: Total Joint Construct — $4,200.00
If a CAP code is missing
If the CAP code is missing, the individual items will show at their full line item prices instead and the case will likely reject. In this case:
Reject the case back to the rep with a comment specifying what's needed (e.g., "This case requires a CAP code for the construct — please add and resubmit.")
The rep will add the CAP code in Item Details and resubmit.
If something looks off
If the total doesn't match what you'd expect, or you see individual items priced unusually high, reject the case back to the rep with a comment describing the discrepancy. The rep can review and correct before resubmitting.
If after resubmission the pricing still doesn't look right and you can't resolve it through rejection, submit a ticket with the DO# and our team will investigate.
Still need help? Click the chat icon in the bottom right corner to submit a ticket.
Still need help? Click the chat icon in the bottom right corner to submit a ticket.