Wiki Psychotherapy Billing For Medicare


Cumming, GA
Best answers
I work for a small psychotherapy provider who just became credentialed with Medicare (Palmetto GBA). Our first batch of claims were all denied with CO-16, MA130, & N290. We billed CPT 90832 with no modifier in POS 11. I suspect that I am either missing a modifier, or there is a G code I'm supposed to use. Does anyone have any insight on this?
Were the sessions telehealth? If yes then most likely modifier 95 is needed. I work for a psychology practice in Michigan--we don't bill Palmetto GBA but when I bill Medicare I bill POS 11, MOD 95 for telehealth and just POS 11 for in office visits.
N290 is Missing/incomplete/invalid rendering provider primary identifier.

This is not a modifer issue. This is an issue with identifying the provider on the claim. Is it a solo practice or a group practice? Is the NPI number in box 32a and 33a? If it's a group practice, is the individual provider's taxonomy code and individual NPI in box 24J?

If you want, you can print a HCFA, black out the patient info, and fax it to me to look at (or post it here).
Thank you both for your response. After a very long phone call with Palmetto, I believe we have identified the issue as exactly what Sharon said above. The incorrect NPI was going out in 24J. We are working with our software vendor to fix the problem.
Excellent! Although I'm sorry it took a long call with Palmetto! One of the things that I do in my town is help people who are new to Medicare get their applications in, get their HCFA set up correctly, etc. It's just one of those "we're all in this together" things that I do.