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Modifier U4 Face to Face Sessions

John-Debbie Trunk 4 years ago in Codes/Rates/Diagnosis Modules updated by Sheryl Martin 4 years ago 15

Here is the link that is associated with my question: Regarding MA/PMAP Plans.

How are OPMH practitioners billing these events? It appears authorizations might be required.
Has anyone billed these types of sessions in the past? If so, how would we do this?

Debbie

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We have billed them and have no trouble getting paid by MA or any of the PMAP's. You would only need authorization if the consultations ran over 15 total hours in the calendar year, which we have not had yet. The modifier U4 is not used for face-to-face sessions; it is used only for phone (non-face-to-face) consults. You use CPT 90899, and the various modifiers indicate the time and the method. If you have more than one consult per client in a day, you are supposed to add the time together.


So for a phone consult of 8 minutes, you would use 90899 U8 U4 (add HN modifier for a practitioner). If a therapist attends an IEP meeting lasting two hours, we are only getting paid for the 90899 UC, which is 31 minutes and up. Hope this helps, Debbie. Let me know if you have any further questions.


Sheryl

Thank you Sheryl. Your explanation was indeed very helpful. I may have more questions in the near future.

I appreciate your time.

Debbie

Any chance you have the fee schedule for what each of those services reimburses?

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Hi Community,


Yes. Anyone know what rates MA and the individual PMAP plans are paying at?

Debbie

Thumbs Up Sheryl. You are awesome!


Debbie

Thank you all, you are too kind! :)

Good afternoon,

How far we can retro bill for these based on MA requirement?

Debbie

Okay. I knew the timely filing period for MA was 12 months. I wasn't sure if there was a limitation on this type of billing.


Thank you Sheryl.


Debbie

Since it is a "new-ish" benefit, if you have anything older, you could try putting it through.

Since will be a new billing event, I'd like to start with current and slowly work backwards to test the system. :)

Should be able to go back 12 months. If you have older ones, you can try them. But I wouldn't expect them to go along with that. :)

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