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Medicare Guidelines on Mental Health Billing

Medicare Guidelines on Mental Health Billing

Navigating through the complex medicare guidelines can be a complex and overwhelming task, however, here is the good news, the entire process is merely about using the right CPT codes. Once you understand the significance and the right usage of the codes, you’ve aced the game. However, one needs to be careful while billing as Medicare follows strict rules and regulations for time increments. To avoid any bottlenecks, here’s a listicle of the common CPT codes which are used for mental health billing:

  • 90832 — 30 minutes of individual counselling
  • 96127- Brief behavioral or emotional assessment
  • 96130 — Evaluation services, such as reporting, treatment planning, clinical decision-making, deciphering test results, and giving patients, caregivers, or family members feedback
  • 90838 — Individual psychotherapy with an E/M service for 60 people
  • 90846 — 50 minutes of family therapy without the patient present
  • 99355 — Prolonged services, initial 60-minute period with an E/M service
  • 90834 — 45 minutes of individual counselling
  • 90847 — 50 minutes of family therapy with the patient present
  • 90853 — Group therapy
  • 96136 — First 30 minutes of test administration and scoring
  • 96137 — Additional 30 minutes for test administration and scoring
  • 96131 — Psychological and neuropsychological testing evaluation services
  • 90833 — Individual psychotherapy with an E/M service for 30 people
  • 99354 — Long-duration services, initial 60 minutes
  • 90836 — 45 patients receive individual therapy using an E/M service
  • 90837 — 60 minutes of individual counselling

Now that we have the commonly used CPT codes in place, let’s understand more about the CPT code types, shall we?

  1. Service based codes: These CPT codes can be billed merely once and does not consider the time factor while billing the service.
  2. Time based codes: These CPT codes, as the name suggests, are to be billed as per the time spent with the patient while delivering the service.

General coding

For the diagnosis and treatment of various mental health illnesses and/or diseases, psychiatry and psychology are specialist fields. When services are provided within the parameters of their state licence, clinical practice, and education, references to providers may include both physicians and non-physicians such as clinical psychologists, independent psychologists, nurse practitioners, clinical nurse specialists, and physician assistants.

Only when individual psychotherapy is the main component of the treatment plan can CPT codes for individual psychotherapy be utilised. When pharmaceutical or evaluation and management (E/M) services or other CPT codes are better applicable, psychiatric service CPT codes shouldn’t be utilized.

Billing Guidelines

E/M and psychotherapy must be major and separately recognizable services in order to be reported together. The reporting of E/M and psychotherapy on the same date of service does not necessitate a separate diagnosis. Psychotherapy is not included in the scope of services. In all contexts, psychotherapy codes are payable. Additionally, unless the beneficiary has taken part in a different and unique group therapy session, CPT Code 90853 shouldn’t be charged for the same beneficiary more than once per day. Modifier -59 should be included in the CPT code for the second session in the rare instance that a patient has separate and distinct individual psychotherapy and group therapy sessions on the same day.

Billing during the actual time of the service

A lot of doctors invest a lot of time in advising patients or managing patient care. Counselling is described as a discussion with the patient, their family, or another caregiver about one or more of the following topics in the CPT nomenclature for Evaluation and Management (E/M) coding: Diagnostic results, impressions, and/or proposed diagnostic studies, Prognosis, the advantages and disadvantages of management (therapy) alternatives, Instructions for management (treatment) and/or follow-up, the significance of observing the management (treatment) options selected, the elimination of risk factors, and patient and family education. Thus, due in part to the differences in requirements between private and public insurers, billing for mental health treatments in a primary care context can be difficult.

The Concept of Medicare Coverage

Fortunately, Medicare may provide coverage for mental health services for beneficiaries who are dealing with mental health issues. A system of treatment known as mental health services aims to evaluate, diagnose, treat, and counsel anybody who requires assistance in reducing the signs, symptoms, ailments, and disorders associated with mental or emotional illness. This can be done in an individual or group setting.

Wrapping Up

Regrettably, the landscape of mental health billing services is always shifting. It seems like there are constant changes taking place in the world of mental health billing. You can’t expect to always be “in the loop” about events. You merely need to look after your clients, while we take care of the rest. At Medisys Data Solutions, we pay close attention to any modifications that have an immediate effect on the billing procedures used by your business and automatically make changes to accommodate you.? Pick your professionals, today!

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