Wiki Mental Health Prolonged Services

jreg96

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Anyone have experience with prolonged service codes? We've been billing 90837 with place of service 03-school (we are a school based MH agency) and 99354 for prolonged services. The code description is: Prolonged evaluation and management or psychotherapy services in the office or other outpatient setting requiring direct patient contact beyond the usual service, first hour.

I can't find anywhere that says that 03-school does not qualify as an "other outpatient setting" but nothing saying that is does either. Our claims are denying this line with: Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim.

90837 TG
+99354 TG

Any tips on billing the prolonged service would be super helpful
 
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