Wiki LCSW In home E/M and psychotherapy


DeKalb, IL
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Trying to get an LCSW to provide in home psychotherapy/counseling to a patient who is covered by Cigna primary and Medicare secondary. Cigna advises that they do not accept CPT codes 90791 or 9083x for in home psychiatric assessments or psychotherapy and advised me to utilize E/M codes 99341-99350 as applicable. However I thought LCSW cannot bill E/M and asked Cigna's rep about this, she stated those codes covered LCSW services in home. Anybody know if this is true?

Then, as I was reviewing the CPT codebook in my research, it states under Home Health procedures that there are separate codes 99500-99600 to be reported by non-phsycian health care professionals (LSCW?) and that physicians should utilize the home visit codes 99341-99350 and NOT use the 99500-99600 codes for additional procedures. It states that health care professionals who are authorized to use E/M 99341-99350 can report the 99500-99600 in addition to the E/M 99341-99350 if both services are performed. E/M services may be reported separately using mod. 25 IF a separate identifyable E/M svc above and beyond the home health service.

Can the 99500-99600 codes be billed as standalone services? Or they are only to be used with the E/M?

I'm SO CONFUSED. Does anyone know what is the correct way to do this? I'm pretty sure it will be denied due to the practitioner license level if I submit the E/M codes 99341-99350 for LCSW even though the Cigna rep stated to. It sounds like the correct code is 99510 Home visit for individual, family or marriage counseling is the one I would need but I don't know if I can bill that on it's own.

To further complicate my questions, is there any indication that Medicare as secondary pays on this type of visit?

I'm currently on hold with Cigna to specifically inquire about this but any help or experience you all could lend would be so greatly appreciated.

EDIT**CIGNA RESPONDED**that this LCSW has the E/M codes 99341-99350 in his contract and they are billable, covered services. They also state the 99510 code doesn't even come up as a service so it's definitely not covered. Now my question is, will Medicare accept the E/M codes when secondarily billed? I'M STILL SO CONFUSED
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You're correct that an LCSW may not bill E&M, and even if they could, it would not be appropriate to report an E&M code because that is not the service that they are performing. For purposes of billing Cigna, I would look into finding a HCPCS code that they would accept, perhaps S9127 or G0155, or maybe try to find someone at Cigna who is a little more knowledgeable about the coverage of this in their plan (probably easier said than done).

As for Medicare, I'm not very experienced with their home health billing and coverage requirements for this situation, so you may need to do a little more research but maybe someone else can post more information. But a lot of non-physician home health services for Medicare have to be billed on a UB form and you might also need to be providing care as part of a licensed home care agency in order to qualify to bill LCSW services in the home. I do know that you won't get any payment from Medicare for 99510 if you bill on a professional claim form though, as that code is a status 'I' (invalid) on the Medicare Physician Fee Schedule.
Thomas thank you, I am sorry I didn't see your response sooner. I agree, a call to a higher level rep at Cigna is necessary, and I am definitely following up on what Medicare will require and what is allowed for non-physician, in-home services. I also looked up the fee schedule and saw that the 99510 wasn't covered by medicare which is unfortunate since it seems the most representative of the provided service, but hey what can ya do...will update if new information is found in my research. Thanks again!