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Credentials to bill E/M

  1. #1
    Salisbury, MD
    Default Credentials to bill E/M
    Medical Coding Books
    Hello Everyone!
    I need some help. Can someone point me to a reference where it says you have to be a MD, NP, mid-wife, or PA to bill an E/M service. We have a psychologist (PhD) who states she cannot bill E/M consultation, because she is not credentialed at that level, which I do think is correct, but I cannot find where that is documented anywhere.

    Lynn Busby, RN, CPC-A

  2. #2
    North Carolina
    I actually had someone ask this the other day. Maybe this will help...

    Psychologists provide—but are not recognized by Medicare for—these E/M services: consultations, psychotherapy for patients who either are on psychotropic medications or have other physical medical illnesses that affect their mental health, and care provided to nursing home residents. Psychotherapy and psychological testing now account for the majority of Medicare billing by psychologists. Nonetheless, in circumstances where a psychologist's work is more appropriately defined as E/M, the psychologist should be permitted to bill for those services provided to Medicare beneficiaries.

    There's a PDF version of this article at the end of the site.

  3. #3
    Louisville, KY
    Although APA supports this, keep in mind there is nothing from the government authorizing a change in rules. I responded in the Behavioral Health section of the forum with some references.

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