Looking for information on billing 99354/99355 amd 90839/90840

Hi Tina. I don't have an answer, but a similar question. What is the difference between the 99354 and the 99355? I too know that both codes are add-ons. I've had success billing just one unit of the 99354 in the past, but unsure of exactly how to bill a two hour, non-crisis, extended session. Anyone? 

Morning

99354 is 30-74 minutes and 99355 is 74-104 minutes beyond 90837.

If you go beyond 104 minutes you bill an additional unit for every 30 minutes.

2 hour crisis.....bill  90839 and 90840 is 30 minutes. So you would bill 90839 and 2 units of 90840.

Hope this helps

I understand these add on codes (99354 and others) are only billable with Med management (evaluation and management). Is that how you are billing these?

That's a great question and one I actually have too? No, we are billing only for psychotherapy, not med mng. Can these codes (99354 & 99355) be used for just psychotherapy alone?

We don't do med mgmt, and have had success billing these codes.  With MN Medicaid, you can now bill extended with family psychotherapy too (90847 only, not 90846).

Here's what I billed and what BCBS did: (appt 2:00pm - 4:00pm)

90847

99354

99355

BCBS paid the 90847 and the 99355, but denied the 99354 with a carc code of 16. 

What are your thoughts?

Thanks, Sara

Hey Tina, Thanks. Can you elaborate exactly how the 90840 code is set-up then. Like you mentioned above is it set-up always one unit, etc or is it a fixed time/unit ratio? And I assume that would be the same for the 99355? That is assuming it IS okay to bill the 99354 & 99355 for psychotherapy without med mng. Also, when a prolonged session happens do you first adjust the appointment time to reflect one appointment or break it up?

Ex:  1:00pm-2:30pm appointment all in one 

OR 

       1:00pm-2:00pm 

       2:00pm-2:30pm  (if this makes any sense) :)

Thanks! Sara

For 90840 I have it set up as 30 minutes per unit.

When the provider bills they change the # of units.

90 minutes would be 90839 90840 (1unit)

120 minutes you would change the units to 2

You would bill 90837-99354 (99354 is always 1 unit) if your session went an additional hour beyond 90837.....this would be for 120 minutes.

Each additional 30 minutes beyond 120 minutes you would bill 90837-99354-99355 (99355 is set up as 30 minutes/unit.)