Question Is a modifier required if 90837 and 90853 are billed on same day but by different providers from different locations?

nwhite123

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Do you know if a modifier is required if a patient is seen for individual therapy (90837) at one location but group therapy (90853) at another location (2 different providers and locations) on the same day?

Thank you!
 

SharonCollachi

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Are the two different providers part of the same group practice? Also, when I was in mental health at least half of the insurance companies would not pay for both an individual and a group visit on the same day. Things may have changed.
 

SharonCollachi

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If they are not connected, then there is no reason to use a modifier. Most offices wouldn't even know that their patient saw another provider the same day.

Will they both get paid? That depends on if the insurance allows two psychotherapy visits on the same day. About 20 years ago I was working for a psychologist who did group and individual counseling. We had one participant that could not do group and individual on the same day. And we had one patient who saw a psychiatrist (not in our practice), and that psychiatrist liked to bill the combined E&M-plus-psychotherapy codes, and if that psychiatrist got their bill in before we did (for just psychotherapy), ours would get denied since the patient was only allowed one psychotherapy visit per day. Of course, it only took one instance of us making the patient pay for their visit with us for them to stop scheduling with their psychiatrist the same day they scheduled with us.
 
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