behavioral sleep therapy

schacon

Networker
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43
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I work for a psychologist who's patients are referred by sleep medicine for behavioral sleep therapy. So Magellan who is the carve out for mental health ( Blue Shield is the health plan) is denying claims with the therapy code 90832-90837 with dx G47.00 of insomnia because payer only pays F code dx. Has any one been getting denials for this?
 

SharonCollachi

True Blue
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1,980
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Clovis, CA
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Most plans will not pay a mental health provider without a mental health diagnosis. Is there ANYTHING else the patient has? Are they anxious or depressed due to insomnia?

We have this issue now, in a different way. We are licensed to prescribe Suboxone for addiction, however, many of the local groups have carveouts for mental health/substance abuse, and we are not contracted with those carveouts. Therefore, we cannot see those patients.

If the patient has no other diagnosis other than insomnia, you may not be able to see those patients for that carveout, OR the patient may have to agree to be cash pay.
 

schacon

Networker
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These patients are referred by sleep medicine for behavioral sleep therapy for insomnia and there is nothing else. Thank you so much for your help!!
 
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