Wiki payment reduction when billing psychiatric code with an office visit

[stacyciccone]

Is there any information regarding a reduction of payment to a provider if a psychiatric code is billed with an office visit?

Example: 99214 and 90833

Also Is there any information regarding a reduction of payment to a provider if an office visit or psychiatric visit is billed with modifier 95 for telemedicine?

Thank you in advance!

Stacy C.

 

[thomas7331]

Since 90833 is an add-on code, there would not normally be a payment reduction involved with the use of this code because under most fee schedules that code is already valued as a extra service provided in addition to the base code. I have not seen any payment reductions applied to codes billed with modifier 95 from the payers I've worked with. However, ever payer sets their own payment policies and fee schedules, so it's possible that some payers or some plans may make reductions in one or both of these situations.

 

[TThivierge]

Hi Stacyciccone
Do you have each of the CPT linked to proper dx? The CPT 99214 is linked to medical health dx (example HTN I10) and CPT 90832 linked to a mental health dx (example Mood DO F06 ) might make it reduce fee. Our provider must document in minutes used for illness for CPT 99214 and behavioral health illness for CPT 90832 on med record. We add modifier 95 each claim line too with both CPTs. the reduction might be coming from the dx/illness of the patient.
I hope this data helps you.
Lady T