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Thread: Psychologist Consult

  1. #1
    Join Date
    Apr 2007
    Salisbury, MD

    Default Psychologist Consult

    AAPC: Back to School
    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 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; I know that Medicare follows that policy, but does that standard hold true for all insurance companies? This would be for a one-time consult for an eval for bariatric surgery.

    Thanks so much!
    Lynn Busby, RN, CPC-A

  2. #2
    Join Date
    Apr 2007
    Louisville, KY


    Most insurance companies are more restrictive of mental health providers than Medicare, if that's any help.

    Noridian has a great tool for mental health services.


    It is common practice that Medicare does not pay for CSW or CP codes submitted with an E/M component. Even if Noridian is not your Medicare Contractor, I'd certainly pursue information from that source. Otherwise, your option would be to contact the various commercial payers and ask for a formal recommendation. By the way, in some of the largest national healthcare systems, Medicare rules are adopted as the gold standard--regardless. That could certainly support you in establishing a general rule to go by.

    Hope this helps.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  3. #3
    Join Date
    Apr 2007
    Salisbury, MD

    Default Thanks

    Thanks. The link you provided was very helpful!

  4. #4

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