H0001 & 90791

lizziemcd

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Solon, OH
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I work for a behavioral health agency that is 84 & 95 Medicaid certification. For our services a biopsychosocial assessment 90791. As an initial assessment they are doing a SUD assessment H0001. What are the thought of billing for both within 30-60 days?
 

OpenClaims

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337
Location
Miami, FL
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Because 90791 is a Psychiatric diagnostic evaluation and H0001 is for alcohol and drug assess, this should be ok to bill. I would be more hesitant to bill if you were billing for H0031 (mental health) since those two would be redundant. In this case, you are evaluating and assessing two different things, so you should have no issues. Just make sure you include any supporting documents and make sure the DOS are accurate.
 

OpenClaims

Expert
Messages
337
Location
Miami, FL
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Because 90791 is a Psychiatric diagnostic evaluation and H0001 is for alcohol and drug assess, this should be ok to bill. I would be more hesitant to bill if you were billing for H0031 (mental health) since those two would be redundant. In this case, you are evaluating and assessing two different things, so you should have no issues. Just make sure you include any supporting documents and make sure the DOS are accurate.
I responded previously to your newest post then came across this so I thought I would copy/paste my response in case you didn't see the other. Good luck.
 

Robyn07

Networker
Local Chapter Officer
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84
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Tucson, AZ
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I agree with the guidance above. The 90791 is the Psych Eval by a non-MD. The Medicare guidance is it can be performed 1 time per year unless there are additional conditions or symptoms identified that need to be evaluated. It will be denied, however, will be paid when sent with medical records upon submission of appeal.
 
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