Wiki HCPCS Codes not payable by Medicare

[rhunter007@att.net]

The following codes are not payble by Medicare, H2017, H0015, H2035, H0038, and T1023, Medicaid will pay but not Medicare. Does anyone know what codes equivalent to these H codes that are payable by Medicare?

Thanks,
Ronda

 

[Pam Warren]

Generally speaking the H codes are reported to Medicare using psychotherapy codes. You'll want to look at the Local and National Coverage determinations and articles to validate how Medicare covers these services. I wouldn't be able to give you a 1:1 crosswalk because it depends on who the billing providers are and what goes on during the treatment sessions. This is one of those instances where coders get to use their research skills!

 

[sls314]

Here is a link to MLN Matters: Medicare Coverage of Substance Abuse Services to help get started on your research.

It contains links to other CMS documents that will help steer you towards information for your provider type:

https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1604.pdf

 

[rhunter007@att.net]

Here is a link to MLN Matters: Medicare Coverage of Substance Abuse Services to help get started on your research.

It contains links to other CMS documents that will help steer you towards information for your provider type:

https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1604.pdf

Thank you!

 

[rhunter007@att.net]

Generally speaking the H codes are reported to Medicare using psychotherapy codes. You'll want to look at the Local and National Coverage determinations and articles to validate how Medicare covers these services. I wouldn't be able to give you a 1:1 crosswalk because it depends on who the billing providers are and what goes on during the treatment sessions. This is one of those instances where coders get to use their research skills!

Thank you!

 

[lissaotto]

I have the same issue! Not to mention we are not participating with Medicare, so there's that part as well. I know it's a silly question, but for Medicare do you use the 1500 form with Modifiers like Medicaid?