Interactive Complexity and Translation Services

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Hello behavioral health coders! In my state (Colorado), Medicaid uses this document as guidance on how to use the interactive complexity add-on code (90785). This guidance references interpreter or translators attending the appointment with the patient as a possible factor in utilizing the code, which leads to questions regarding if the code can be used "to pay for translation services". These guidelines have this note: "Per the center for Medicare and Medicaid Services (CMS), '90785 generally should not be billed for solely for the purpose of translation or interpretation services' as that may be a violation of federal statute". I am unable to find this guidance from CMS anywhere, does anyone have any idea what federal statute is being referred to? We are having an extended conversation about this at my place of employment, any input would be very much appreciated!
 
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I have never heard of that "federal statute". Of course there is interactive complexity if you have to add a third party to interact with the patient.
 

cgaston

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The "Federal Statute" being referred to is section 1557 of the Affordable Care Act: Under the Final Rule, "oral and written language assistance services must be provided free of charge, in an accurate and timely fashion and must protect the privacy and independence of the individual with Limited English Proficiency".


Using 90785 to bill for translation or interpretation services would violate the statue because these services need to be provided free of charge.
 
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The "Federal Statute" being referred to is section 1557 of the Affordable Care Act: Under the Final Rule, "oral and written language assistance services must be provided free of charge, in an accurate and timely fashion and must protect the privacy and independence of the individual with Limited English Proficiency".


Using 90785 to bill for translation or interpretation services would violate the statue because these services need to be provided free of charge.

Ah, okay, I get it now. I would probably argue that as long as you are not billing the patient, it is okay. If I recall, the ACA is about the patient, not about the insurance company. I don't think there is a prohibition to the doctor against charging the insurance company... it's just free of charge to the patient. I would have to do more research on that aspect of it to know for certain.
 

thomas7331

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CPT 90785 represents the additional work to the provider involved in a psychotherapy service when one of the four listed communication difficulties are present, which includes cases where a translator or other individual needs to participate in the care. The code itself is an add-on to a psychiatric service but does not represent the translator service itself, or the provider's costs in obtaining a translator. So it would only be inappropriate if billed just to represent translator services, or to represent interactive complexity outside of the specific context for which the code is intended to be used. (For example, it should never be used as an add-on to an E&M service to bill for the cost of the translator to a provider during that encounter.) But it is appropriate to use as an add-on code for an eligible psychotherapy service when a translator need to be involved because this does result in an increased complexity to the provider's work.

There are a few payers that do reimburse for translator services - this can be billed with HCPCS code T1013.

CMS has also published guidance on this code here:
 
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