MA client seen at 2 clinics in same day

dianef 2 years ago in Billing/Electronic Modules updated by td.vanovermeiren 2 years ago 2

I have a therapist who saw a client for a DA, and the billing was denied because the client was seen at another clinic on the same day. (CP case) Is there any way to get reimbursed for that DA? Crisis add-ons wouldn't work?

Were they seen for a DA at the other clinic as well? I know most payers will not pay another CPT code when they pay for a DA on the same DOS. I believe, if you're the one who did the DA and the other agency did something other than a DA, you should be able to at least attempt to get an auth to cover your DA. You just have to show WHY you had to do the DA (previous DA from other agency was not complete, or did not suggest CTSS which your agency felt was appropriate, etc.).

Try using a 59 modifier with the DA