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?

none have come in since October 16th and unable to send the ones today.  Any suggestions?? TIA! 

We have not been able to submit electronically to Hennepin Health PMAP all year (2025) - we have contacted them, they have our practice listed as active - no idea why.   They don't answer the phone, the email system just sends an endless loop to 'register', which we have done 3 times.  

Anyone else having issues with them???

Do not know what this field is actually supposed to contain when entering a Medicare or Medicare Advantage plan into a patient's payer - not finding anything at CMS either.  Anybody have an idea???

I was told by a Medical Assistance rep that we need to have a claim status of 16 when billing a Medicare Advantage plan to MA...I am not sure how to make this happen...ideas or suggestions???