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96119 payment by CMS

sspain

sspain

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22
Location
Tyler, Texas
I have a client who has been denied payment by OIG of CMS for 96119. The client has a technician administer a comercially available computerized test to assess cognitive ability of patients at risk. Since 96119 is a covered service when properly provided/documented, I wonder if anyone else has run across payment issues when a computerized screening tool is administered by a technician? If so, what was your experience? Thanks!
 
sspain said:
I have a client who has been denied payment by OIG of CMS for 96119. The client has a technician administer a comercially available computerized test to assess cognitive ability of patients at risk. Since 96119 is a covered service when properly provided/documented, I wonder if anyone else has run across payment issues when a computerized screening tool is administered by a technician? If so, what was your experience? Thanks!
Click to expand...

All of the code's requirements were met?
-Was it a face-to-face assessment?
-Did a qualified healthcare professional provide a written interpretation and report?
-Were the hours of the technician's time properly documented on the claim form?
-Was the proper ICD-9 code assigned for the condition, and was it a covered indication for the test?

This article may be useful to you: http://www.cms.gov/MLNMattersArticles/downloads/MM5204.pdf

:cool:
 
The short answers are: yes, yes, not sure, and yes. However, upon investigation, I think the computer assisted testing should perhaps have been billed under 96120. I am awaiting word from the testing vendor to see what CPT they recommend for billing their test. I will also check to be sure my client was not billing BOTH 96119 with 96120 for these encounters. Thank you for the link. This info was reiterated in the CMS Psych Services manual updated Jan 2011.
 
sspain said:
The short answers are: yes, yes, not sure, and yes. However, upon investigation, I think the computer assisted testing should perhaps have been billed under 96120. I am awaiting word from the testing vendor to see what CPT they recommend for billing their test. I will also check to be sure my client was not billing BOTH 96119 with 96120 for these encounters. Thank you for the link. This info was reiterated in the CMS Psych Services manual updated Jan 2011.
Click to expand...

Haha! Glad I could help! :)
 
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