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Billing two therapy codes

TessaLasky 4 years ago in Meaningful Use updated by Debra Pietsch 4 years ago 3

Has anyone had experience with billing two therapy codes in one day to UCare PMAP? For example, we are trying to bill code 90853 (group) and 90837 (individual) for a client on the same day. UCare will only pay one or the other it seems regardless of what I do. I did use the 59 modifier.

In my experience, services for individual and group therapy must be delivered on different days to avoid claim denials.

It just depends on the payer. I believe UCare uses a different modifier when two services are billed in the same day - 77? 77 if "Repeat procedure or service by another physician or other qualified health care professional". 76 if "Repeat procedure or service by the same physician or other qualified health care professional". Some just won't pay more than one service on the same day, no matter how many calls you make. Good luck!

We have found the same thing it really depends on payer.  However, most carriers we find do not pay for two services on the same day by same provider and they usually will pay the lower fee of the two.