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Wiki Secondary billing for IOP add on codes

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KristinAJohnson

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When billing an IOP to Commercial payers, I use a 90853 code. When it's time to bill the Medicaid payers as Secondary, the IOP is broken down into 96164 for the first 30 minutes and then a 96165 for the additional time. My question is, how should I reflect the adjudication from the Commercial Payer on the Secondary claim? Is the payment applied to the 96164? And if so, what adjustment code should I list for the 96165 because I don't want to list the remainder as a contractual adjustment nor is it patient responsibility. What adjustment code should I use to indicate that I expect the secondary to pay it's portion of the complete IOP charge?
 
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