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I recently started billing and coding for a Therapist/Counselor for substance abuse. I am billing all insurance as out of network. My claims are continuously getting denied. How should I be billing out of network for a substance abuse therapist?
 
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You'll need to tell us why they are being denied, and what you're billing.
one of my denials is for code T1023. Is there an alternate code for T1023?

I am billing initial group therapy sessions (using the T1023 code), individual counseling sessions, and continued counseling group therapy sessions.
 
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Has the insurance told you they wanted the T codes instead of the regular CPT codes?
No, BCBS has only told me the T code is denied/non payable. We assigned the HCPCS code because it most accurately coded our counseling session. Should we assign a CPT code instead? Maybe CPT code 96130 is comparable to T1023? Do you thing HCPCS code G0410 or G0411 would be appropriate?
I was just informed that the code is probably 90791. My manager thinks this is the code. If anyone knows different please let me know.

Thank you for all your help!! I really appreciate it!!!
 
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SharonCollachi

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Generally, each patient will have an individual evaluation to determine if they are a good fit for group therapy.

If your provider is an MD, they will bill 90792 for an evaluation.
If they are NOT an MD, they will bill 90791 for an evaluation.

Individual psychotherapy is 90832-90838.
Group therapy has several codes, 90853 is the most commonly used.

96130 is psychological testing, which would be used if the provider were administering an MMPI or similar instrument.
 
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Generally, each patient will have an individual evaluation to determine if they are a good fit for group therapy.

If your provider is an MD, they will bill 90792 for an evaluation.
If they are NOT an MD, they will bill 90791 for an evaluation.

Individual psychotherapy is 90832-90838.
Group therapy has several codes, 90853 is the most commonly used.

96130 is psychological testing, which would be used if the provider were administering an MMPI or similar instrument.
Thank you so much!! that is very helpful!!!

My email is Magdalene5836@gmail.com. Is it possible for you to email me so that I have your email in case I have any other questions?
 

CarlaA

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Generally, each patient will have an individual evaluation to determine if they are a good fit for group therapy.

If your provider is an MD, they will bill 90792 for an evaluation.
If they are NOT an MD, they will bill 90791 for an evaluation.

Individual psychotherapy is 90832-90838.
Group therapy has several codes, 90853 is the most commonly used.

96130 is psychological testing, which would be used if the provider were administering an MMPI or similar instrument.
I work family practice clinic that is owned and staffed by NPs. We are currently preparing to expand into mental health as well. My question is you stated that a 90792 would be billed if the provider was an MD, but could you also bill this for a NP since they can also write prescriptions and treat patients?
 

SharonCollachi

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I work family practice clinic that is owned and staffed by NPs. We are currently preparing to expand into mental health as well. My question is you stated that a 90792 would be billed if the provider was an MD, but could you also bill this for a NP since they can also write prescriptions and treat patients?

When I said MD, I should have said "someone that is allowed to perform and bill Evaluation & Management codes". Sorry. I was only thinking of MD vs. PhD.

In your scenario, be aware that for many insurances you have to be credentialed for their mental health panel, AND many insurances have carve-outs to specialty mental health plans. Just because you take Anthem Blue Cross PPO doesn't mean that's who you bill for mental health; it could be a different company.
 

CarlaA

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When I said MD, I should have said "someone that is allowed to perform and bill Evaluation & Management codes". Sorry. I was only thinking of MD vs. PhD.

In your scenario, be aware that for many insurances you have to be credentialed for their mental health panel, AND many insurances have carve-outs to specialty mental health plans. Just because you take Anthem Blue Cross PPO doesn't mean that's who you bill for mental health; it could be a different company.
Thank you!! I kind of figured that is what you meant but I just wanted to clarify as this is new territory for us. And we are working on reaching out to ALL of our insurances that we credential with to see if there is anything we need to do to make sure we are in network.

Again thank you so much!! It is very much appreciated!
 
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