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Billing for group/individual sessions at a substance abuse facility

  1. Default Billing for group/individual sessions at a substance abuse facility
    Medical Coding Books
    I have just recently started a job at a substance abuse facility. We offer both group sessions (billed under 90853, lasting approximately 1.5 hours) and one-on-one sessions (billed under 90804 and 90806, lasting between 30 minutes and an hour). If a patient comes in and has both a group session and a one-on-one session in the same day we bill only for the group session. It seems to me there should be some modifier to allow for billing of both services, much like the -25 modifier for E/m. When I asked, none of the other staff (none of whom have any coding background) could help me. Due to the nature of our treatment, 95% of our clients are billed to medicaid/managed medicaid, if that has any effect on the issue. Is there a way to bill for both services?

  2. #2
    Default
    My question to you is- Is this outpatient treatment or inpatient treatment. What state are you from?

  3. #3
    Location
    Madison Area Chapter in Madison WI
    Posts
    113
    Default
    Quote Originally Posted by gryphonkessira View Post
    I have just recently started a job at a substance abuse facility. We offer both group sessions (billed under 90853, lasting approximately 1.5 hours) and one-on-one sessions (billed under 90804 and 90806, lasting between 30 minutes and an hour). If a patient comes in and has both a group session and a one-on-one session in the same day we bill only for the group session. It seems to me there should be some modifier to allow for billing of both services, much like the -25 modifier for E/m. When I asked, none of the other staff (none of whom have any coding background) could help me. Due to the nature of our treatment, 95% of our clients are billed to medicaid/managed medicaid, if that has any effect on the issue. Is there a way to bill for both services?
    I can't answer the Medicaid billing, but from a commercial perspective, many carriers will cover both services if they provided during different sessions by different providers. There has been a lot of discussion on which modifier to use, 25 or 59 modifier. Since the services aren't technically E/Ms or procedures, I can give you a documentable answer, but I vote for the 59. I wonder if others have any thoughts on it. Thanks.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  4. Default
    We've billed the group session with a 59 modifier and some insurances pay it, but some don't allow two services on the same day and will not pay it.

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