mc1030
Contributor
Hello All,
I have been getting the run around with this problem. Our provider will do psychological testing and have one day of service as telehealth whereas the rest of the encounter is not since testing can continue on multiple of days. The codes will be 90792,95, 96130 + 96131x2, 96131,95. We are getting denied for the services not in telehealth stating missing modifier. Payor will reimburse the code with 95, but deny the rest.
I had received two answers from two people stating that if only one day is telehealth and the rest is not, do not mark it as telehealth (remove the telehealth appointment type or remove modifier 95 which the practice is highly against).
For me, I would assume its best to have the telehealth service on a separate claim or the actual date of service so it doesn't fire that missing modifier rule since not all services is telehealth. I am being told though that every testing encounter MUST be on the same claim using the same date even if it was on different dates of service. If anyone has any experience when it comes to this please any advice would be greatly appreciated. I have relied on the CMS website billing for the psychological testing and the APA as well but it does not clarify how to submit the claim when telehealth is involved. I am not sure if it is the telehealth modifier that's really causing this issue or if another modifier is to be use when it comes to psychological testing.
I have been getting the run around with this problem. Our provider will do psychological testing and have one day of service as telehealth whereas the rest of the encounter is not since testing can continue on multiple of days. The codes will be 90792,95, 96130 + 96131x2, 96131,95. We are getting denied for the services not in telehealth stating missing modifier. Payor will reimburse the code with 95, but deny the rest.
I had received two answers from two people stating that if only one day is telehealth and the rest is not, do not mark it as telehealth (remove the telehealth appointment type or remove modifier 95 which the practice is highly against).
For me, I would assume its best to have the telehealth service on a separate claim or the actual date of service so it doesn't fire that missing modifier rule since not all services is telehealth. I am being told though that every testing encounter MUST be on the same claim using the same date even if it was on different dates of service. If anyone has any experience when it comes to this please any advice would be greatly appreciated. I have relied on the CMS website billing for the psychological testing and the APA as well but it does not clarify how to submit the claim when telehealth is involved. I am not sure if it is the telehealth modifier that's really causing this issue or if another modifier is to be use when it comes to psychological testing.
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