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EncoderPro.com Expert

EncoderPro.com Expertprovides online access to a powerful search application for all CPT®, HCPCS Level II, ICD-9-CM, and ICD-10-CM and PCS code sets as well as Optum360 and Medicare coding guidelines to ensure coding accuracy, improve billing performance, and reduce rejected claims. Complimentary monthly updates let you code confidently throughout the year. Plus, a compliance editor powered by Optum360’s ClaimsManager helps you review your code selections, and a fee calculator computes the Medicare reimbursement rate for your region.

Key Features and Benefits 


  • Expert Exclusive—Enhanced claim review. (includes Optum360’s ClaimsManager rules) Check your work by running your selected codes through an edit check to ensure proper unbundling, correct modifiers, complete diagnoses, and more prior to submittal to a clearinghouse/vendor/payer. Includes a 24-month historical content database for use during claim adjudication. Over 130 coding rules are reviewed.
  • Expert Exclusive—Fee calculator. Calculate the adjusted Medicare reimbursement rate for your area.
  • ICD-10-CM and PCS– Includes mapping content from ICD9 v1  v2, and v3 codes to ICD10-CM and PCS codes (as well as backward mapping) using the GEM (General Equivalency Mappings) and Optum360’s MapSelect clinical mapping content.  Also includes ICD-10-CM and PCS searching and Optum tabular (ICD10-CM and PCS books) content.


Plus all of the valuable features of EncoderPro.com Professional:

  • Optum360 Edge—Powerful CodeLogic™ search engine technology. Keyword search across all code sets (including ICD-10-CM and PCS) simultaneously using up to four terms, acronyms, abbreviations, or even misspelled words.
  • Optum360 Edge—Lay descriptions for procedures and HCPCS. Access comprehensive Coders’ Desk Referencedescriptions for thousands of procedures and services to enhance your understanding of CPT® and HCPCS code differences.
  • Optum360 Edge—Automatic monthly updates. Real-time application service delivers code changes before implementation and updates Medicare coverage information regularly for coding confidence.
  • Local coverage determinations (LCDs) and Medicare’s Pub. 100 access. Check procedures for Medicare coverage instructions and medical necessity edits across all CMS MACs. Understand which ICD-9-CM (and ICD-10-CM) procedures define medical necessity and what the documentation guidelines are for successful claim submission. Gain insight into procedures and services that carry little or discretionary coverage and how to report them.
  • Modifier crosswalk. Choose from a comprehensive array of modifiers for each procedure based on millions of claim scenarios to ensure correct modifier use when billing payers.
  • Cross-coder relationships. Provides valuable content from 12 coding and billing specialty reference books in one powerful solution. Cross-reference procedures to radiology, path/lab, medicine codes, and more.
  • Medicare CCI edits. Understand coding relationships for bundled and mutually exclusive procedures and check your code combinations through a full year of CCI.
  • Color-coded edits. Reduce research time and improve coding accuracy with at-a-glance sex or age edits, Medicare coverage, and bundled procedures.
  • User notes. Easily identify codes or code groups requiring more personal or company information.           
  • Notepad. Store your most frequently used codes for easy access and export your codes to Windows programs.
  • Great value. Includes the content from more than 30 code and reference books in one powerful solution.


CPT® is a registered trademark of the American Medical Association.


The price of EncoderPro.com Expert does not include add-ons. Add-ons sold separately.

AHA Coding Clinic for HCPCS Add-on (Item WA03) $125 per user, per year
AHA Coding Clinic for ICD-9-CM Add-on (Item WA02) $250 per user, per year

Claims Batch Editor Add-on (Item WA16) $500.00 per physician, per year

Repair Toolkit for Claims Batch Editor Add-on (Item WA18) $250.00 per physician, per year

Coders’ Dictionary Add-on (Item WA05) $75 per user, per year

Coder’s Essential 3-Pack (Item WA22) $399.95 per user, per year

CPT® Assistant Add-on (Item WA01) $250 per user, per year
CPT® Changes Add-on (Item WA27) $199 per user, per year

CPT® Assistant/Changes (unrestricted) Add-on (Item WA37) $329.95 per user, per year

The AMA Content Module Add-on (Item WA34) $399.95 per user, per year

The CDI Add-on (Item WA35) $249.95 per user, per year

Dental Codes Add-on (Item WA23) $19.95 per user, per year

ASA Crosswalk® (Item WA24) $199.95 per user, per year

DrugReimbursement.com Add-on (Item WA08) $499.95 per user, per year

Historical Application Content Add-on (Item WA11) $149.00 per user, per year

Stedman’s Dictionary Add-on (Item WA04) $125 per user, per year

I10 Map Manager (Item WA26) pricing determined on size of organization



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