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Billing PMAP's for H0001 w/HF Modifier (Rule 25 Assessment)

Jeremy Roelofs-Lynch 1 year ago in Billing/Electronic Modules updated 4 months ago 8

Does anyone bill their Rule 25 Assessment with a HF Modifier?


This was just brought to my attention that for PMAPs (UCare/Hennepin Health) we can bill the Rule 25 with the Modifier and bill the Comp Assess without it. The R25 would pay per our contract and the Comp Assess would pay the 162.24.


Any feedback would be greatly appreciated. 

Just came here with a question along the same lines!

Here's what I bill:

- Rule 25s for all PMAP plans with H0001 & rev code 0900

- Comps - UCare & Henn Health with H0001 & 0944 or 0945 rev code

I have a BCBS bulletin that says to bill the Rule with the HF modifier.  


What I'm looking to find out is how organizations are billing Rule 25s to Medica/Optum?  I can't find information anywhere.  I had a bulletin at a prior job but didn't keep a copy so I have no clue.

Hi Heather! We are successfully billing our R25s with the HF modifier (PMAPs) which allows us to bill the Comp at the higher rate.  

Medica/Optum - where do I start. I have had a lot of issues with them and getting our contract fixed is like moving mountains.

    • Rev Code = 0900, HCPC = H0001, Modifier = HF (on a UB04) is what we bill and our contract is supposed to be set up as but currently they are telling us to bill on a 1500 with a CPT -- which is wrong for us. 

If you have better luck with them, please let me know! 

Jeremy

Thanks for your response Jeremy!  What rev code are you billing comps to Medica with?  I tried the 0944 or 0945 with HCPC H0001 and those are being denied.  We use rev code 0953 when billing our treatment services.  We don't do many R25s here so it's mostly the comp billing for Medica I need to problem solve.

We bill our comps with 0944 or 0945 with HCPCs, also being denied. I have a meeting with Optum next week to figure out why things are not paying appropriately. 

Would you be willing to post what you find out here, or email or call me personally?

Of course! Why don't you send me an email and I will flag it to reply next week after my meeting on Thursday morning. 

Jeremy Roelofs-Lynch

Billing Manager

jroelofslynch@parktx.com


We recently contracted with the county to give R25. So you guys bill right to the insurance but just note it's a R25 by the modifier correct and / or revenue code it looks like?

We were wondering how they differentiate / if we would have to send the county the bill. 

Hi Jenna, when we bill PMAP insurance for R25 Assessments we are placing the HF modifier on them to indicate it is a R25 SUD Assessment. When billing the county for a Comp Summ, we do not use a modifier.