Results 1 to 2 of 2

Substance TX and Private Insurance Billing

  1. Default Substance TX and Private Insurance Billing
    New Call-to-action
    I bill for a group practice that is fairly new to private insurance. Our main payer is state medicaid. I am having a hard time trying to get info on how to bill private insurances when services are rendered under a certified addiction counselor...the state of Maryland acknowledges CAC's but most private insurances don't credential them but they do credential the LCSW's or LCPC's who are the supervising providers of each location. Cigna doesn't recognize supervising and I know this isn't the same as "incident to" billing as that is only in a physician setting. I bill on CMS 1500 and trying to figure this out. In most of our offices the CAC or CSC holds the assessments OP or IOP groups for substance tx, how is this billed under private insurances? Any help or hindsight would be greatly appreciated.

  2. #2
    Location
    Harrisburg Pennsylvania Chapter
    Posts
    45
    Default
    You will most likely need to use a modifier for the CAC, which is HF. If the supervising is a social worker and a modifier is needed, the mod for them would be AJ; for LPC's, the mod is HO. The supervising may or may not need a mod -- each insurance is different, so someone will need to research this.

    When doing verification of benefits, you will need to ask the rep specifically if they cover services provided by a CAC under the supervision of a LCSW or LPC. They might ask you for a DX and CPT codes, so if you have this info, it will be helpful in determining whether or not ins will pay.

Similar Threads

  1. Billing Auto Insurance vs Private Insurance
    By kathymoon in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 03-02-2019, 02:51 PM
  2. Medicaid patients having private insurance
    By cghanbari in forum OB/GYN
    Replies: 3
    Last Post: 09-02-2015, 10:41 PM
  3. Flu Vaccine/Private Insurance
    By CentroMed in forum Billing/Reimbursement
    Replies: 0
    Last Post: 08-31-2015, 02:00 PM
  4. Private Insurance Paying 75% of Medicare Lab
    By tlh4hart in forum Medicare Regulations
    Replies: 1
    Last Post: 11-30-2013, 08:52 AM
  5. Ncci edits - private insurance
    By lindaboop in forum Medicare Regulations
    Replies: 1
    Last Post: 02-01-2013, 10:16 AM

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.