Billing 99354

sfoster 1 year ago in Billing/Electronic Modules updated 1 year ago 4

Has anyone else experienced problems when billing the 99354 add-on code for an extended session for 2023 DOS? Claims are rejecting in the Electronic Module. This was a BCBS commercial policy.

Stating the following:

Error Message: Category: Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Status: Line information

Error Message: Category: Acknowledgement / Rejected for relational field in error. Status: Procedure code for services rendered

Error Message: Category: Acknowledgement / Rejected for relational field in error. Status: Date(s) of service

Error Message: Service Line Data: SVC*HC:99354*120*****1~Version: 5010A1 Loop: NA

Thanks, Sara

I've been advised this CPT code has been discontinued. I had the same experience with UMR claims. This CPT Code 99354 was replaced with 99417 however, that CPT code may not be allowed. We found this information - "Here is an interesting analysis on 99417 and 418 by Moda Health, a health insurance company based in Portland, Oregon."

Neither 99417 nor 99418 may be reported with psychotherapy procedure codes; no prolonged
services procedure code is available for this situation.
a. Dr. Peter Hollmann, Co-Chair of the CPT/RUC Workgroup on E/M, explained the
psychotherapy participants in the E/M Revision workgroup indicated a prolonged service code
is not needed for psychotherapy services. (Hollman25)
b. Should providers disagree with this decision, they will need to work directly with their
professional specialty society/association to have a request submitted to the AMA for a new
procedure code to be created for this purpose

I don't have any further information. I did submit a claim using 99417 that replaced 99354. The claims have not processed. Time will tell how the payer views the replacement code.


yes the 99354 code was discontinued as of 12/31/22.  If you google for a replacement some articles state the 99417 replaces it but if you look further, it states that the 99417 code can only be billed with 99205.  So most of us Mental Health agencies are not able to then bill that code and more articles then state that there hasn't been a true replacement code established yet for it.  So we are basically out of luck until such a replacement code is established. 

For straight Medicaid clients, we can now bill a qty 2 of 90837 for extended sessions. Does anyone know if the PMAPs also allow this? 

I'm excited to try this. What does that mean for the billing tab on the 90837 cpt code regarding time/unit/ratio I wonder?