90899 Information

John-Debbie Trunk 7 years ago in Codes/Rates/Diagnosis Modules updated by Sheryl Martin 7 years ago 7

Hello , ,

Is there anyone who can provide information regarding CPT Code 90889. What kind of process do we need to follow to get reimbursed for this codes. Is it covered by PMAP plans, MA, Commercial Payers, if so which ones?  Does it require prior authorizations. Thank you.

Each payer seems to have their own way of processing the 90899's - or of not processing. Even some of the PMAP's are sticky when processing them. If there is a commercial payer as primary, and MA or a PMAP as secondary, if the commercial payer is processing it as CO and not PR for the rejection, that can mean you can't forward it to the secondary payer. Some payers are even denying at the clearinghouse - so the claim doesn't process at all - which makes the MA/PMAP deny for not submitting to the primary. We have been dealing with this for about as long as the code has been billable. There is another thread in this user community which might be helpful to you, as well. The title is as follows:

CMH Clinical Care Conultation

That might help, a lot!

90899, Preparation of Report, is often - probably usually - either specifically excluded by contract ("not a covered benefit") or is considered to be a service that is "incidental to" another service (the report writing activities are considered to be an essential part of the other service, such as psychological testing) and therefore it would be denied.  It would be interested to hear from others who have been paid for 90899 to find out what sorts of reports were considered to be reimbursable.

Richard, as I understand it, the report preparation cpt is 90889.  Is this correct?  

Yes. It is often  labeled "preparation of report," but I believe the full  official label is, 

“Preparation of report of patient’s psychiatric status, history,
treatment, or progress (other than for legal or consultative purposes) for other physicians,
agencies, or insurance carriers." Also, I believe that is billed "per occurrence," not by the hour. 

I think we are having some confusion here (90889 vs 90899).  I don't know if the original question was about the 90889 or the 90899...

Yes, i contributed to the confusion by reading the original question, about 90889, but then making a clerical error when discussing it by shifting to 90899.  Sorry.  My info was intended to be for 90889.

Thanks for the clarification, Richard.