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H0015

J

JJcodes

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7
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Chugiak, AK
I cannot find specific guidelines on the H0015 code. The definition says "operates at least 3 hours a day and 3 days a week" but what if a patient is uncooperative with treatment and refuses to attend group? Do you still bill the H0015 because the service is offered and available or do we have to not bill it all?
 
Cpt h0015

Hello
Which payer of yours is using CPT code H0015. I assuming that Medicaid of Virginia is the payer so check Medicaid of VA website and the billing codes are listed and how to bill. If it is by another payer check their guidelines. Also check the HCPCS manual for this H code. If there is not documentation on the client from case manager or doc you cannot bill. The case manager needs to document whatever took place but if client did not stay or participate then you cannot bill.

I hope this information aided you.:)
 
Our facility does not take Medicaid but we have private payers that do reimburse us on the H0015 (not much but it is something). I can only find the basic definition of the H0015 in the different policies so am going off of the definition in the HCPCS. I felt like I was going out on a limb trying to deal with how to charge an uncooperative patient but it looks like there will be no reimbursement here. Thank you for your feedback, its one of those things you hope you can stretch but it is what it is, lost revenue. Thanks a bunch for the reply, I just needed a second opinion.
 
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