2017 CPT CODE UPDATE ORDER FORM FOR RIDGEMARK
Due to licensing limitations imposed by the AMA and the fact that Pulse Systems, Inc. provides code updates to you in a format that allows import into RidgeMark, you are now required to purchase the CPT code updates for a nominal fee that covers the license fee to the AMA. In order to receive the 2017 CPT codeupdate, you will be required to complete this order form and remit information regarding the number of users along with your payment to Pulse Systems, Inc.. Pulse Systems, Inc.will then remit paymentto the AMA.
To purchase CPT updates for RidgeMark, please complete the information on this form and fax it to Gail Mosher at (810) 735-0073. If you have any questions regarding this form, the code update product or process, please call Customer Support at (800) 525-1101. Payment by credit card is required. We will charge your card at the time that your order is received. When we have processed your order we will provide you with instructions to download and install the new codes at that time.
IMPORTANT: If youDO NOT wish to purchase the 2017 CPT Codes, check this box
Then fill in your name and your company name below, and fax this form to (810) 735-0073.
Your Company Name:
Your Pulse Systems, Inc. Account Number:
Contact Name:
Contact Phone or Email:
Number of Users That Will Be
Using the CPTcodes:
The AMA has a specific definition of a user – please refer to their definition below when responding to this question for your practice.
Calculate Your Price:
# UsersPrice per UserExtended Price
CPT Updates $21.00+ tax if applicable
Credit Card Number:______
Expiration Date: ______
Card Holder Name:______Security Code (3 or 4 digit #):
Authorized Signature:______Date:______
* * * * *
The AMA definition of "user" is – an individual who:
(1) accesses, uses, or manipulates CPT editorial content contained in theelectroniclicensed product either at the input (the point at whichdata is entered), the output (the point at which data, reports and the like are received), or both; or
(2) accesses, uses or manipulates the electronic licensed product to produce or enable an output that could not have been created without the CPT embeded in theelectronic licensed product even though CPT editorial content may not be visible or directly accessible; or
(3) makes use of an output of an electronic licensed product that relies on or could not have been created without the CPT editorial content embedded in theelectronic licensed product though CPT editorial content may not be visible or directly visible.
Pulse Systems, Inc. interprets this definition to include all users involved with posting (charge and payment), billing, administration and reporting. Please check with the AMA if you are unsure of how to classify someone in your office.