Question Spravato Billing for Behavioral Health

Messages
5
Location
Katy, TX
Best answers
0
I work for a BH office where they administer Spravato with the minimum monitoring for 2 hours. Has anyone been having issues with Magellan when billing an OV and the add on? We were told to use 99215 and +99417 as the add on code due to the AMA making changes at the beginning of the year. Last year we billed the 99214 +99354&99355.
 

SharonCollachi

True Blue
Messages
2,168
Location
Clovis, CA
Best answers
3
I don't work in behavioral health any longer, but extended time codes are for active time. For example, if the patient is sitting in your office and having vitals taken every 15 minutes for two hours, you don't bill two hours of extended time. You bill the actual time spent on the patient by a licensed clinician. The spravato instructions say to measure BP at 40 minutes and thereafter until the BP declines to a clinically acceptable number. If the patient is hanging out for 40 minutes, you don't get to bill that. If a medical assistant takes the blood pressure, you don't get to bill that. You bill for the clinician's time. If in total they spend five minutes reviewing the patient's vital signs, then you're not going to be billing any extended time.
 
Messages
5
Location
Katy, TX
Best answers
0
I don't work in behavioral health any longer, but extended time codes are for active time. For example, if the patient is sitting in your office and having vitals taken every 15 minutes for two hours, you don't bill two hours of extended time. You bill the actual time spent on the patient by a licensed clinician. The spravato instructions say to measure BP at 40 minutes and thereafter until the BP declines to a clinically acceptable number. If the patient is hanging out for 40 minutes, you don't get to bill that. If a medical assistant takes the blood pressure, you don't get to bill that. You bill for the clinician's time. If in total they spend five minutes reviewing the patient's vital signs, then you're not going to be billing any extended time.
So I have a question, can extended time and prolonged services be used interchangeably? I've been told by the person that used to lead Spravato that when the provider is taking notes, prepping the patient for the medication administration etc. that all of that can all be billed for. The 99417 code includes with or without direct patient contact, so with the provider taking notes that is included in the prolonged portion. I am just trying to get a better understanding because someone else used to handle this, and just recently everything was dumped on me. The Spravato REMS also states the mandatory 2 hour minimum observation requirement, so they've had me sending that information in when trying to get reimbursed.
 

CBLENNIE

Networker
Messages
29
Location
Meridian, ID
Best answers
0
There are specific HCPCS codes G2082 & G2083 to be billed by a qualified healthcare provider's services for patient's visit and the 2 hours of time (the recommended/typical time) spent supervising the patient after the medication is administered. The codes are broken down by the dosage administered. Here is the link to the Spravato provider website's FAQs for access & reimbursement.

Spravato Access & Reimbursement Guide

Below is a snip of the information on billing for your provider's services for the visit and supervision of the patient after the medication is administered. This information is included in the linked guide above.

1622664831610.png
 
Messages
5
Location
Katy, TX
Best answers
0
There are specific HCPCS codes G2082 & G2083 to be billed by a qualified healthcare provider's services for patient's visit and the 2 hours of time (the recommended/typical time) spent supervising the patient after the medication is administered. The codes are broken down by the dosage administered. Here is the link to the Spravato provider website's FAQs for access & reimbursement.

Spravato Access & Reimbursement Guide

Below is a snip of the information on billing for your provider's services for the visit and supervision of the patient after the medication is administered. This information is included in the linked guide above.

View attachment 5363
This would be an option if we were charging for the medication as well, but we actually receive the Spravato through a REMS pharmacy so we are supposed to bill an OV and prolonged services code. On page 16 of the Spravato reimbursement is where this information is located. I actually based my information that I told my providers at the beginning of the year on information I received from Spravato, but thank you for your input. Some insurance companies are just being a little more difficult.
 
Messages
6
Location
Perry, UT
Best answers
0
I am really struggling with thus "unit" issue. Everything I have read indicates that you are not to bill anything under a full 15 minutes as a unit, But if you look at the chart previously posted, it shows that for payers following Medicare guidelines, you don't count the first unit until you've reached 69 minutes. For payers that aren't following Medicare guidelines and using CPT 99417, the first unit starts at 55 minutes. Isn't that a contradiction to "you don't bill anything under a full 15 minutes"? If I'm not looking at this the correct way, please let me know! I have had several discussions with my provider on this and we both have some doubts that we are doing this correctly. Any insight from those who've billed these charges, please enlighten me. :)
 
Messages
214
Best answers
0
I am really struggling with thus "unit" issue. Everything I have read indicates that you are not to bill anything under a full 15 minutes as a unit, But if you look at the chart previously posted, it shows that for payers following Medicare guidelines, you don't count the first unit until you've reached 69 minutes. For payers that aren't following Medicare guidelines and using CPT 99417, the first unit starts at 55 minutes. Isn't that a contradiction to "you don't bill anything under a full 15 minutes"? If I'm not looking at this the correct way, please let me know! I have had several discussions with my provider on this and we both have some doubts that we are doing this correctly. Any insight from those who've billed these charges, please enlighten me. :)
No matter when you start counting time for the add-on code the total time for the add-on service must = 15 minutes. If you start counting at 55 minutes for a new patient, the doctor/QHP must perform an additional 15 minutes before you can bill the add-on code. Same thing if you start counting at 69 minutes and for the times for 99215.
See the chart in your CPT manual for sample times for the CPT guidelines.
 
Top