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Billing 90862 for a Medicaid patient

  1. Default Billing 90862 for a Medicaid patient
    Medical Coding Books
    Is there an alternate code for 90862 that Medicaid will accept? I received a denial today, stating that they do not recognize it on their fee schedule.






    Thanks,

    Maria, CPC-A

  2. #2
    Location
    Ellenville, New York
    Posts
    1,176
    Default What was done?
    Need more information on what was done to answer the question. Could be an E/M code, psychotherapy if the "minimal" amt of time was sufficient to use that code, etc.

    What state are you in? NY Medicaid has recognized that code for a long time.

  3. #3
    Default
    Hawaii Medicaid also accepts 90862. I wonder if they are denying you because of frequency limits or the diagnosis not supporting medical necessity. In Hawaii, a patient is allowed only 12 in a given year.
    Donna E. Young, CPC

  4. Default re: what was done
    Hi,

    I'm in PA. 90862 was the only thing done on that date of service; Dr. saw patient at a nursing home.


    -Maria

  5. #5
    Default
    Quote Originally Posted by mariak81586 View Post
    Is there an alternate code for 90862 that Medicaid will accept? I received a denial today, stating that they do not recognize it on their fee schedule.






    Thanks,

    Maria, CPC-A
    Hello, If the patient has only medicad insurance. I suggest that using 90899 - unlisted pyschiatric service or procedure that the medicad or medi- cal will accept the service bill.


  6. Default
    Isn't there a HCPCS code equivalent to 90862??

  7. Default
    Medicaid of GA wants M0064. The physicians services manual states the following under Physician Services Limitations:

    "When the sole purpose of the visit is to monitor or change
    psychiatric medication, only code M0064 shall be billed"

  8. #8
    Default
    Quote Originally Posted by mariak81586 View Post
    Hi,

    I'm in PA. 90862 was the only thing done on that date of service; Dr. saw patient at a nursing home.


    -Maria
    Are you sure that MA isn't denying because POS?

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