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Wiki 90791

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Pkirsch1

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Location
Bristol, CT
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Hello,

We have a doctor that is transitioning from his Private Practice to our Practice, (bringing in his clients) and wants to know if he can use a 90791 for their first session even though he is already their therapist and treatment isn't newly beginning from a clinical perspective? I know they can only use the 90791 one time per year (using the same NPI) for clients over 21, and 2 times per yr under age 21, but is this considered MEDICAL NECESSITY?

Thanks for your help!

Pamela
 
This sounds like BC/BS policy. Medicare allows a combination of 3 90791/90792 per 'rolling year'. You can appeal these denials from insurers, but you're probably fighting a losing battle. Why would a doctor be using 90791 instead of 90792, Just use established E/M codes if medical or psychotherapy codes if clinical
 
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