Wiki Can an fqhc facility bill for 90853?

[JuarezD]

HELLO,

I work for a FQHC medical facility, we are trying to figure out if there is any way that we can bill for group therapy. Anyone have any thoughts? Since we are a FQCH facility we cannot bill for an E/M code, or behavior and intervention.

Thank you in advance

 

[cjtown]

Per the Medicare Benefit Policy Manual
Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services

170 - Mental Health Visits
(Rev. 220, Issued: 01-15-16, Effective: 02-01-16, Implementation: 02-01-16)
A mental health visit is a medically-necessary face-to-face encounter between a RHC or FQHC patient and a RHC or FQHC practitioner during which time one or more RHC or FQHC mental health service is rendered. Mental health services that qualify as stand-alone billable visits are listed on the FQHC center website,

http://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center.html, and the RHC center website, https://www.cms.gov/Center/Provider-Type/Rural-Health-Clinics-Center.html.

Services furnished must be within the practitioner’s state scope of practice.
Medicare covered mental health services furnished incident to a RHC or FQHC visit are included in the payment for a medically necessary mental health visit when a FQHC or RHC practitioner furnishes a mental health visit. Group mental health services do not meet the criteria for a one-one-one, face-to-face encounter in a FQHC or RHC.
A mental health service should be reported using a valid HCPCS code for the service furnished, a mental health revenue code, and for FQHCs, an appropriate FQHC mental health payment code. For detailed information on reporting mental health services and claims processing, refer to Pub. 100-04, Medicare Claims Processing Manual, chapter 9,
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c09.pdf

Medication management, or a psychotherapy “add on” service, is not a separately billable service in a RHC or FQHC. Rather, they are included in the payment of a RHC or FQHC medical visit. For example, when a medically-necessary medical visit with a RHC or FQHC practitioner is furnished, and on the same day medication management or a psychotherapy add on service is also furnished by the same or a different RHC or FQHC practitioner, only one payment is made for the qualifying medical services reported with a medical revenue code. For FQHCs, a FQHC mental health payment code is not required for reporting medication management or a psychotherapy add on service furnished on the same day as a medical service.

Hope this helps.
Carla​

 

[kbrooks15]

Even though there are visits that are non-covered FQHC visits for Medicare, is it possible to bill them to get a denial to bill the secondary insurance? I am curious about this.

Or is it that they cannot be sent in at all?