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Billing for Clinical Care Consultation

Alyson Zurek, LICSW 10 months ago in Codes/Rates/Diagnosis Modules updated by Sheryl Martin 10 months ago 7

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?

Here is a link to the FAQ page on the state's website:

https://mn.gov/dhs/partners-and-providers/training-conferences/childrens-mental-health/mhcp-clinical-care-consultation-faq.jsp

We have a problem getting the commercial payers to deny in a way that the PMAP's will pay it when there are two payers on a client's account. We are a CTSS certified agency, but from what I understand, this is not a CTSS-specific code. It seems like it is, because the commercial plans don't pay it, but it isn't.

Here is a link to the Children's Mental health Clinical Care Consultation portion of the Mental Health Services Provider Manual: https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_198190

Hope these help!

We are a private practice; we do get paid by MA, PrimeWest, etc.  Both phone and in-person.

Hi Sheryl,

I'm hopping on this feed hoping to obtain clarity for billing this CPT code 90899. Can you tell me the credentials for the clinical staff you are billing this code for?

Thank you so much,

Debbie

LMFT and practitioners under supervision.

Thank you both for responding!! I looked at the link. I can see that it is clearly spelled out for Children's mental health and we will pursue that. I did notice as I dug deeper that it may be used for adults (over 21) as well, not as clearly spelled out but available nonetheless. Do either of you have success billing the code/procedure for adults who have MA?

Yes, we have been paid for adults - all PMAP's from the looks of it.