Wiki BH - Multiple visits within a 12-hour period - MCO

[jrienne.belarmino@icloud.com]

Question on same-day psychotherapy billing (90832 & 90834)


I’m looking for guidance on billing psychotherapy services performed on the same date of service.


Scenario:

• Patient has two psychotherapy visits on the same day
• CPT codes: 90832 and 90834
• Different rendering providers
• Same payer (Medicaid managed care)
• Same clinic / billing provider

Question:
Should these services be billed on one claim with two line items, or separate claims, given that the rendering providers are different but the DOS and payer are the same?


I’m especially interested in guidance based on CPT rules, CMS/Medicaid guidance, or payer policy, rather than system-specific workflows.


Thank you!

 

[Pam Warren]

I'm assuming that this is an outpatient clinic, these are professional claims, each provider has their own NPI and that the services have been pre-authorized, are medically necessary and a diagnosis is provided.

Both CMS and commercial payers want separate claims based on separate provider numbers.

 

[jrienne.belarmino@icloud.com]

I'm assuming that this is an outpatient clinic, these are professional claims, each provider has their own NPI and that the services have been pre-authorized, are medically necessary and a diagnosis is provided.

Both CMS and commercial payers want separate claims based on separate provider numbers.

Thank you for confirming. Yes, this is an outpatient clinic, and these are professional claims.