Wiki Billing frequency of CPT 90791 and 90792

[tamaramorrow]

Good Afternoon,

Can someone please assist me. We are a Behavioral Health Clinic (FQHC). How often can the above CPt's be billed? is it considered an initial visit or subsequent or both? unable to find a specific billing guideline from CMS. Thank you!

 

[twhite@work]

Frequency of 90791 and 90792

Once per day there is a MUE of 1 with a MIA of 3 which means the code has a date of service edit allowing for it to be billed only once per day
MAI 3: Date of Service Edit: Clinical
MUE MAI "3" indicates a date of service (DOS) edit based on clinical benchmarks. Payers who apply the MUE sum the code's same-DOS units (not counting lines with modifier 55). If the sum exceeds the MUE value, the payer will deny same-DOS lines with that code on the current claim. MACs may pay excess units upon appeal or may bypass the MUE based on documentation of medical necessity.
Also Try Medicare LCD L34616 for specific guidelines.
Since you are a FQHC read this also https://www.cms.gov/Medicare/Medica...Downloads/FQHC-PPS-Specific-Payment-Codes.pdf
There are some specific codes that represent these code (90791,90792) for a IPPE and Annual Well Visit for Medicare patients G0469-New patient and G0470 Established patient.

Hopes this helps. I used to work for and FQHC and some of the guidelines are specific to FQHC's only and it can make it a little more challenging to find info.