0

How do you bill an add on code with an authorization?

Laura Hulsey 5 years ago in Billing/Electronic Modules updated by Sheryl Martin 3 years ago 6

Example: a client has Medical Assistance and exceeds the allowed number of units of therapy in a calendar year. A KePro auth is obtained for the add on psychotherapy code, but when billed is sent on same claim with the primary code that does not require authorization. How do other providers handle this?

Thank You.

The auth just needs to be attached to the add on code, not the primary that doesn't need an auth. In the authorization tab of the client module, enter the auth number, # of units, date range and code the auth is for and it should just attach to that code.

Thank you Crystal for your response... got that part of it.... what is happening is that because the add on code may not be billed on a separate claim than the primary code, MA sees BOTH the primary code and add on code under the auth # and denies the primary code.... procentive has indicated the add on code may not be billed separately. I've tried unsuccessfully to enter manually on DHS website MN-it's (to bill only for add on code). Wondering if anyone else has this issue. Appreciate any feedback

We haven't run into this situation ourselves but because the add-on code requires an auth and it has to be billed with the main code, you might have to get an auth for both. Not sure how you would do that now though because they would have to be the same auth number from MA so that they appear on the same claim when you submit the claim to MA.

Laura, are you billing the claim initially and then find out the add on code needs an auth? Then you obtain the auth and have to resend it? If that's the case, I think what I've done in the past is send a replacement claim and do the replacement with BOTH codes, but technically the primary code has nothing changed to it, just that you have to send it for the add on that now has an auth. Hope this helps. I don't know how successful I've been with getting add on codes paid after they denied due to no auth. Some payers I feel like want you to send in a paper claim and write 'corrected claim' on it, but I prefer trying electronically.

+1

Yes, above scenario exactly.... I will try that. Thank you so much!!

+1

I know this is an old topic, but I went through this exactly in the past, did it wrong, had to write off the add-ons. Don't want to have to explain that to the boss again!


When you do an authorization for MA, you can put multiple CPT's on the same authorization. For instance, several I did last year, I included 90837, 90834, 90832 and 90785. That way, if a session is shorter than usual, you are still covered under the authorization. You can ask for different number of units for different CPT's.


Hope this helps somebody! :)