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?



CLIA UA testing reimbursement MNMA?

Teri 3 months ago in Codes/Rates/Diagnosis Modules updated 2 months ago 2

Does anyone out there know how to submit CLIA UAs for MNMA clients? 

I am told that because we are not a lab, we cannot submit UAs to them. 

Has anyone else had this issue? If so, who do I submit to? 

We are not a lab but we do perform UA quick dips and cups. We are only getting reimbursed by a few MCOs.

Thanks for your help, Teri


Drug Testing Billing Code Question - Saliva

Does anyone bill for drug testing using saliva samples instead of urine? We are presently using 80305 and 80307 for urinalysis. It looks to me like we can use the same codes for saliva testing but I am posting this question to see if other providers have had to code for this method. 



Hey Everyone! We started billing Psych testing codes and I am needing some help. When billing a 96131 I know with Blue Plus you are only able to bill 7 units per date of service. Does anyone know about Ucare or other PMAPS rules?




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 11 months ago in Codes/Rates/Diagnosis Modules updated by sarah 11 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 12 months ago in Codes/Rates/Diagnosis Modules updated by SEHowes 11 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 2 years ago in Codes/Rates/Diagnosis Modules updated by ahuseby 2 years 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.