Wiki Billing Code H0031 help!

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nhpa2016

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I have a provider who billed BCBS/NH code H0031 with a GAD diagnosis. The claim denied because the code is not on the providers fee schedule. BCBS is advising me that if I can resubmit with the H0031 but a different non-covered diagnosis code then it would deny as a non-covered and the provider can collect from patient. I am really at a loss I have never billed the H0031 code and just need any help I can get with this.
 
H0031

Hello,
What type of provider? Was this a mental health visit of some sort or are you trying to capture for screenings performed during an encounter in a physician office? I think you may need a different code because it's my understanding that H codes are used for billing Medicaid and are not typically used for commercial payers.

Becky Johnston, CPC, CPPM
 
MH Provider H0031

Hello! This is a LCMCH/MLADC who saw the patient in his office. I didn't bill the original code and have never billed this code H0031 it is new to me. Does this code have a crosswalk code that should be billed to commercial carrier instead of the H code? Here is what I know:

Patient was seen in the office and code H0031 was billed with a diagnosis for General Anxiety Disorder. The code is not on the fee schedule as you mentioned because it is not a code that is billed to commercial carrier. The issue is that the code denied for not being on the provider fee schedule and would be provider responsibility.

This is not my strength I am not a coder and have no idea where to go with. Any help would be great!
 
The best bet would be to have the payer provide a copy of the fee schedule?

It will likely have some if not all of the following codes on it 90791, 90832-90838, 99201-99215, 99221-99225

H codes are typically only accepted by commercial payers for drug treatment only
 
Where are you located and who is the payor? I'm currently working on some NY HCBS services and welcome the opportunity to connect with others and compare notes.
 
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