2020 CPT Update Form

To order your 2020 CPT codes, please fill in the blanks below and fax a signed copy of this page to our office at (985) 646-1676. Per your order, your practice will see the user license fee of $ 50.00 per user plus applicable sales tax added to your next invoice from us. In addition, you will also be provided, via the email address* you provide in your order below, a receipt as notification that the 2020 CPT codes have been uploaded to your system. Make sure that the email address you supply is a valid email address, as it will be used for future communications from us when we need to provide additional information to you about your system. If you have any questions, please call our office at 800-248-4298 or via email support@duxware.com.

Date _______________________

Practice Name __________________________________________________________________

Number of users accessing CPT files __________

This form authorizes Medical Practice Software, Inc. to update the CPT® code set in my DuxWare
software. I agree to, and will pay the license fee for this code update which is $ 50.00 per user.

Authorized by _____________________________________________________________________
Printed Name _____________________________________________________________________
Telephone ____________________________________________
Email: _______________________________________________

Current Procedural Terminology (CPT) is copyright 2019 American Medical Association. All Rights Reserved.
No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data
contained herein. Applicable FARS/DFARS restrictions apply to government use.