96116 - Neurobehavior Eval

janetmoh

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We got a denial from our billing company for a medicare claim for 96116. We received a "Message 16" whatever that is. Then further on it says MA130 - basically incomplete and/or invalid information. Our billing company is saying that we need a referring provider (our billing company has made mistakes in the past). I thought that was only required for consultations (E&M codes). Can anyone point me in the direction of where it says a referring provider is required or what a message 16 is?
 

janetmoh

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Well I found an answer to my own question:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5204.pdf

If the psychologist is an indepent provider, then they need to have a referring. But it looks like if they are part of a practice, then they do not. In my case, they are part of a facility. I don't understand why this is an issue now; we've never had a problem in the past. There have been changes at our billing company, and I'm wondering if they are billing it as an independent??
 
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