99354

[Mhbc]

My provider is lcsw and she has sessions with her patients for 1.5 and I billed the 90837 with the 99354 and the claim got denied. Please explain what I need to do to get this to be approved. Let's start with BC.

 

[trarut]

Please provide the denial and remark codes from the insurance denial; otherwise, anyone who tries to help is simply guessing.

 

[nlynn112211]

I am also having issues with denials for 90837. We always bill with modifier AJ and a lot of the denials mention incorrect/invalid/missing modifier or it will deny as non-covered. This specific example is from Anthem BCBS commercial plans and Anthem Medicaid plans. There is no other modifier to use that we know of and one is required. Does anyone else have this issue?

 

[Dfreddie]

I'm having issues also with 90837. The patient is seen by an LSCW, no other visits this day. I've tried with and without modifier AJ - but I'm still getting denial code 4, procedure code inconsistent or missing modifier. Any suggestions?

 

[SharonCollachi]

My provider is lcsw and she has sessions with her patients for 1.5 and I billed the 90837 with the 99354 and the claim got denied. Please explain what I need to do to get this to be approved. Let's start with BC.

As requested above, the specific denials would need to be provided. Most insurances do not allow a 90 minute psychotherapy session.

I am also having issues with denials for 90837. We always bill with modifier AJ and a lot of the denials mention incorrect/invalid/missing modifier or it will deny as non-covered. This specific example is from Anthem BCBS commercial plans and Anthem Medicaid plans. There is no other modifier to use that we know of and one is required. Does anyone else have this issue?

When I billed mental health to either Blue Shield of California or Blue Cross of California (they are not one company here as in other states), they did not want any modifier. Also, if it denies as non-covered, it could be that the mental health is a carve-out plan, OR you're billing for a level of provider that is not covered on the plan OR the specific diagnosis is not a covered benefit. Way too much to know without the specific details (including diagnosis).

For Medicaid plans, they will often use HCPCs codes instead of the regular CPT codes.

I'm having issues also with 90837. The patient is seen by an LSCW, no other visits this day. I've tried with and without modifier AJ - but I'm still getting denial code 4, procedure code inconsistent or missing modifier. Any suggestions?

Who is this being billed to, what is the diagnosis code, is mental health a covered benefit, is the provider enrolled with the plan, etc.?