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

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

Debbie

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.

Thanks,
Kim

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?

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!

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

Hello all, 

I am wondering if anyone has sent their staff to a 30 hour training on billing T1016 for 245G? If so where? We are having a hard time finding a training for this. 

Also has anyone started to bill for this in your CD programs?

thank you ! 

We currently bill all our group/individual sessions under H2035. Once clients complete programming they are welcome to attend our aftercare group that meets on Saturday morning for a coupe hours. Currently this is free of charge; however, we are looking at possibly being able to bill for this service. 

Does anyone else bill for aftercare? If yes, how do you do this if the client was discharged from programming? Do the insurance companies pay? What code(s) do you use?

Any insight would be greatly appreciated. 

:)

Could someone tell me the code that you are billing for on a External DA review and a Explanation of findings