External DA Review & Explanation of Findings

KELLY PERFETTI 2 years ago in Codes/Rates/Diagnosis Modules updated by sarah 2 years ago 1

Does anyone bill for an External DA review & Explanation of Findings.  If so what codes are you using and does insurance pay for this?  Thanks


Modifier U4 Face to Face Sessions

John-Debbie Trunk 4 years ago in Codes/Rates/Diagnosis Modules updated by Sheryl Martin 4 years ago 15

Here is the link that is associated with my question: Regarding MA/PMAP Plans.

How are OPMH practitioners billing these events? It appears authorizations might be required.
Has anyone billed these types of sessions in the past? If so, how would we do this?



New E/M coding criteria for 2021

We do not have professional billers at our organization.  It is required that our providers have an understanding of the codes they are selecting to bill.  With the new changes to the E/M coding we are wondering if we are selecting the E/M level based on Medical Decision Making can we bill both the E/M plus an add on psychotherapy code if the prescriber is providing psychotherapy during the session.  Client is scheduled for 30min appointment the prescriber selects a 99214 based on MDD and provides 20 minutes of psychotherapy can they bill both 99214 and 90833?  Can we bill a 99213 +90833 for a client who is seen for 40 min when selecting the E/M based on MDM? We appreciate any information that may be provided.  


PMAP vs MA Reimbursement

ejallo 5 months ago in Codes/Rates/Diagnosis Modules updated by sarah 5 months ago 1

Does anyone know why some PMAPs pay different rates from MA for the same service/provider? 

It seems like they should be the same since the PMAPs follow MA guidelines. 



Value Code 24 Room and Board Billing MN State

Jen 6 months ago in Codes/Rates/Diagnosis Modules updated by SEHowes 5 months ago 4


We are having claims deny using the Value Code 24 (99920) that we were first instructed to use for SUD Room and Board claims back in 2019.  All claims have paid up until now, all are now denying as a non covered charge.  I have spoke with the provider help desk and they do not see the code we are using on the list.  They also said there have been no updates to the list since it came out in 2019.  I do have the code that they are saying we should be using and will be updating our system and I have set up a case with the state to review.  

I wanted to know anyone else is having this same issue?  We were thinking that it may have something to do with direct access starting 10/01/2020,

Thank you!  


Interactive complexity for telemedicine?

Kim Ross 1 year ago in Codes/Rates/Diagnosis Modules updated by ahuseby 1 year ago 12

Good morning. 

As we bill telemedicine mental health and substance use disorder services for the foreseeable future, we have a question:

Because of the added complexity of the technology, is it appropriate to use the add-on code 90785?

Interactive complexity refers to factors that complicate the delivery of a mental health procedure, as defined:

You should use this CPT code when one or more of the following is present in a session:
  • When delivery of care is complicated due managing maladaptive communication among involved parties.
    • Examples of maladaptive communication include:
      • high anxiety
      • high reactivity
      • repeated questioning or disagreement
  • In a case where the implementation treatment plan is hindered due to caregiver emotions or behaviors.
  • When a discussion of a sentinel event and/or mandated report to a third party is initiated with the patient and any other participants.
    • Child Services/Elder Abuse Services etc.
  • When patients require equipment, devices, interpreters, or translators to work around impediments to diagnostic or therapeutic interaction with a patient.
    • Patients who require this include:
      • patients who are not fluent in the same language as the provider
      • patients who have not developed receptive language skills and are unable to understand typical language
      • patients who have lost receptive language skills and are unable to understand typical language.

Any insight is appreciated.



Billing for Clinical Care Consultation

Alyson Zurek, LICSW 1 year ago in Codes/Rates/Diagnosis Modules updated by Sheryl Martin 1 year ago 7

Can we bill for (and get paid:) Clinical Care Consultation over phone or in person? I've been told by someone who works in a CTSS clinic that they can only be billed for MA clients. Using code 90899 with modifiers. For example U8, U9, UB, UC (in person) and adding U4 for phone.

Can a private practice bill these codes or does one have to be in specific program to use these codes?


Blue Plus denial

Hello everyone,

Wondering if anyone has any experience with billing H2017 HQ - Adult group skills. Blue Plus is denying our claims for this code and modifier.

I spoke with Blue Plus and was told that they do not accept the HQ, and that there are 2 other H modifiers that I could use, but he could not tell me what those were.

Has anyone had any success billing this service?

Thank you!


NEMT Transportation

LaVonne James 2 years ago in Codes/Rates/Diagnosis Modules updated 2 years ago 2

Does anyone have experience billing NEMT (Non-Emergency Medical Transporation)?