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Medicare and Mental health

  1. #1
    Question Medicare and Mental health
    Medical Coding Books

    I am new to coding and billing and work for a non-profit mental health agency here in Maine. We have been billing all claims for Psychiatric Medication Management to Medicaid (called MaineCare in Maine) until 2008 when Medicaid guidelines/regulations changed and we had to change our licensing with the state. We know have a license for Maine that allows to bill services for Psychiatric Medication Management (code H2010 for HCPCS) to Medicaid and to Medicare under 90862 and M0064. The question is do we have to bill Medicare for clients that have Medicare Part B or can we offer to give this service to free? We have been working with a local consulting firm and have been given conflicting information. Our NP is licensed as a PMH-NP and does not require supervision anymore from a psychiatrist or MD. We also have an LCSW on staff that does assessments for us for other services that are reimbursed by MaineCare but no Medicare. We will need to bill his assessments possibly to Medicare for clients that have Medicare and Medicaid if we become contracted with Medicare. Does anyone have a good contact for discussing Medicare contracting questions especially in regards to Mental Health and enrolling?

    Thank you in advance for your assistance.
    Gretchen Lagassee

  2. Default
    If the patient has Medicare primary you would have to bill that first before you would be able to bill Medicaid - which will likely not pay any additional. If a patient has Medicare you can bill and should bill for the medication management (90862) that the NP and MD's are providing. It is a covered benefit under Medicare - we bill them in our office without any problems.

  3. #3
    Default -
    Thanks for the information. I have another question.
    Do you know if we have to have an MD or Medical Director on Staff to bill Medicare? We do not employ an MD or Medical Director currently. Our NP is an PMH-NP and is independent (does not require clinical supervision). We are a non-profit mental health agency. We are not setup as a clinical or an FQHC.

  4. Default
    We bill all of ours with an MD super, but if they are fully liscensed and able to bill on their own and are performing within the scope of their liscence you should be able to bill them. Make sure they are enrolled with Medicare.

  5. Default
    I have a quick question: is H2010 and 90862 essentially interchangeable?

  6. #6
    Default H2010/90862
    No, they are not. H2010 is included in 90862 but is specifically for use when providing services to one with alcohol and drug treatment issues. 90862 is for general purposes.
    Good luck. Hope that helps.
    Anita Johnson, CPC, CCS, CPMA, CCS-P
    Orlando, FL

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