96118 Neuropsych Billing


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I started this position 1/2017 and only had a few days of training from a biller who was with this practice for 6 years.
I had noticed that she was billing 96118 with 12 units but we were only getting paid anywhere from 2.5-4 units, only being paid 4 units when its BCBS. Though this year a lot of insurances are denying 96118 12 units - only allowing 8 units to be billed and then still paying anywhere from 2.5-4 units. Anyone else seeing this issue? It's a lot of time spent for just 2.5 units to be paid for.

Appreciated - thank you!


Harrisburg Pennsylvania Chapter
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You will need to check each payer's policy on what they deem reasonable and necessary for the DX/CPT you are billing. Also, check to see if pre-auth is needed. I am not clear on what you mean when you say that you bill 12 units, but they only pay for 2 - 5. Usually, if they aren't going to pay for 12, the whole claim is denied -- they won't just pay a part of it. Their fee schedule needs to be compared to the fee the provider is billing, and assessed to make sure that they are following their own fee schedule. For example, if the provider bills $100 per unit of 96118, but the reimbursed rate is only $40 per unit, then it will look like $480 is only payment for 4.8 units, when really they paid for all 12 according to their fee schedule.

If the provider is PAR for that insurance company, then they need to accept that rate. However, if they are Non-par, they can balance bill the patient, but the patient should be made aware of this before services are rendered.

If you see a sharp deviation from what has been reimbursed before by an insurance company, then it could be an error within your billing program, or theirs, or a policy change, or changes to the terms and conditions of the patient's insurance coverage. At this point a call to your provider rep is in order.

Good luck!

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