Wiki Psychologist Consult

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lbusby2

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Hello Everyone!
I need some help. Can someone point me to a reference where it says you have to be a MD, NP, mid-wife, or PA to bill an E/M service. We have a psychologist who states she cannot bill E/M consultation, because she is not credentialed at that level, which I do think is correct, but I cannot find where that is documented; I know that Medicare follows that policy, but does that standard hold true for all insurance companies? This would be for a one-time consult for an eval for bariatric surgery.


Thanks so much!
Lynn Busby, RN, CPC-A
 
Most insurance companies are more restrictive of mental health providers than Medicare, if that's any help.

Noridian has a great tool for mental health services.

http://www.medicarenhic.com/providers/pubs/Mental Health Services Guide.pdf

It is common practice that Medicare does not pay for CSW or CP codes submitted with an E/M component. Even if Noridian is not your Medicare Contractor, I'd certainly pursue information from that source. Otherwise, your option would be to contact the various commercial payers and ask for a formal recommendation. By the way, in some of the largest national healthcare systems, Medicare rules are adopted as the gold standard--regardless. That could certainly support you in establishing a general rule to go by.

Hope this helps.
 
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