Behavioral Health billing questions

evwall

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Rocklin, California
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Hello, I'm relatively new to this and would appreciate any help.

I'm billing for a LMFT and am confused on several things:

90791: I have billed 90791 as an initial visit code for this provider, but it seems that some insurances require or pay on 99404. However I'm not sure why/when to use 99404.
Is 90791 an initial visit code for non EAP pts only?

99404-I'm unclear if my provider (LMFT) can use E/M codes (99404), if so, when? I'm unclear why 99404 would be used over 90834, etc.
Is 99404 an initial visit code for an EAP pt? If not is there such a thing?

Modifier HJ: I've used 90837 with HJ as a modifier for EAP pts, but not in every case and have been paid either way which makes me confused about when to use the modifier. Should it be used every time and for all insurances when billing for an EAP pt?


Thanks for all your help, I really appreciate it.
 

Cavalier40

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Stuart, FL Sailfish Chapter
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I work mainly with LMHC and LCSW so I would think some of the principals would cross over to LMFT, as long as the insurance accepts an LMFT as a billable rendering provider.

90791 - This can be done by any non medical MH/SA provider (as long as they can be a rendering provider by the insurance) I have heard 2 different things about this initial visit. One that it follows e/m rules and can only be billed once every 3 years, the other is that it can be billed again after 18 months of no contact with the patient and a new treatment plan is enacted.

99404 - This is a preventive care code. Its actually a time based code (99401-99404 in increments of 15 min, 99404 being the 60 minute code) and is to determine risk factors reduction intervention. I can see why an EAP would want you to bill this on an initial referral since most employees call the EAP when they are in crisis. Also since it is preventive care, you need to have a Z code ICD10

90834 - This is the regular counseling code, again its a timed code (90832,90834,90837 in 15 min increments, 90834 is the 45 min code) This code should be used for an established patient.

Now when it comes to the EAP, I would call them and find out what will be paid under the EAP benefit, and what will be paid under the regular insurance benefit. It it likely that the EAP will pay for the referral visit and maybe up to 4 visits, or maybe just the referral visit......or maybe the EAP for that employer is just a physician referral source for their in network insurance policy and all of the claims will be paid under the regular MH/SA benefit.

The HJ modifier tells the insurance company that the claim is being filed under the EAP benefit. So any claim in which the EAP is paying should have this modifier.

So to sum it up. For a regular non EAP patient, bill the initial with 90791 and subsequent visits with 90832,90834,90837. I would also suggest that all of your documentation is time stamped and adheres to AMA regulation with the amount of face to face time with the provider is needed to fulfill the time requirement of billing with the correct timed code.

For an EAP patient, call the EAP provider, get an idea of their referral method and how many visits they are going to pay, then you might be billing 90791 or 99404 depending on the type of care the patient needs and adding the HJ modifier if the claim is going through the EAP benefit.

I hope I was at least some help.





Hello, I'm relatively new to this and would appreciate any help.

I'm billing for a LMFT and am confused on several things:

90791: I have billed 90791 as an initial visit code for this provider, but it seems that some insurances require or pay on 99404. However I'm not sure why/when to use 99404.
Is 90791 an initial visit code for non EAP pts only?

99404-I'm unclear if my provider (LMFT) can use E/M codes (99404), if so, when? I'm unclear why 99404 would be used over 90834, etc.
Is 99404 an initial visit code for an EAP pt? If not is there such a thing?

Modifier HJ: I've used 90837 with HJ as a modifier for EAP pts, but not in every case and have been paid either way which makes me confused about when to use the modifier. Should it be used every time and for all insurances when billing for an EAP pt?


Thanks for all your help, I really appreciate it.
 
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