CLIA UA testing reimbursement MNMA?

Teri 3 years ago in Codes/Rates/Diagnosis Modules updated by Heather L. Heim 2 years ago 3

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


External DA Review & Explanation of Findings

KELLY PERFETTI 5 years ago in Codes/Rates/Diagnosis Modules updated by sarah 5 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 7 years ago in Codes/Rates/Diagnosis Modules updated by Sheryl Martin 7 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?




John-Debbie Trunk 1 year ago in Codes/Rates/Diagnosis Modules updated by Kim N 1 year ago 3

I'm searching for a billable and payable CPT code for OPMH for a prolonged time with patients. While it may appear that code 99417 is replacing these codes, this code can only be used with certain Evaluation and Management (E&M) codes used by doctors, and cannot be used with psychotherapy codes 90837 or 90847 for extended sessions.Feb 11, 2023

Debbie Trunk


Comprehensive Assessment Update Billing

Dawn 2 years ago in Codes/Rates/Diagnosis Modules updated by Heather L. Heim 2 years ago 1

Hi, we are running into issues when billing the SUD Comprehensive Assessment Update.  The update is normally an hour long appointment as opposed to the two hour long Comprehensive Assessment.  We are wondering what code people are using when billing for the update or are updates not being billed for at all.  Thank you so much in advance for any advice that you have!


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 3 years ago in Codes/Rates/Diagnosis Modules updated by sarah 3 years 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.