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Substance TX and Private Insurance Billing

  1. Default Substance TX and Private Insurance Billing
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    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
    Harrisburg Pennsylvania Chapter
    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.

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