Has anyone billed CTSS codes lie H2014 with UA modifier to commercial payers and have had reimbursement success? Or should we just skip billing primary commercial payers and bill directly to MA/PMAP? Have you had to put PR 96 on the COB info since commercial payers do not reimburse those services/codes? Thanks in advance.

I did an analysis of billed R69's to see who was paying them. (These are generally a first appointment with a parent only--90846.) We have been paid for this diagnosis by Health Partners, PrimeWest, BCBS, Preferred One and America's PPO. We have not been paid by Medica or MA. Their denial description states "Diagnosis not consistent with procedure".

Is anyone billing this as a Z71.1 or a Z03.89? Are you being reimbursed by Medica and/or MA? Thanks in advance!

Sheryl

We are experiencing slowness everywhere

Hello,

Has anyone had claims deny from Health Partners with the code 50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.)?

Since January 1 all our psychotherapy codes have been denying with this code...weird.

Thanks

What do most providers use as a diagnosis for billing when clients come in one time and the therapist does not get enough information to complete a diagnostic assessment?

We are consistently getting denials from MA when billed as secondary saying "missing other plan informaition" - specifically when primary is Medicare or a Medicare advantage plan.  The COB is correct and have tried adding the svd segment manually, nothing works.  Any ideas?

The 2ndary claims stopped rejecting.....but now the primary insurance COB isn't travelling on the MA 2ndary claims so MA denies for missing primary COB- when the COB is populated. Ahh!! help

Anyone receiving denials from BCBS Federal for DBT H codes done via telehealth?  We are getting pushback from them and lots of different answers for MH services in general done via TH stating these services need to be done through Teladoc.