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Assisted Living Facility Coding

  1. #1
    Default Assisted Living Facility Coding
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    Hello everyone,

    I'm new to behavioral health billing and need help. The new dr we are billing for has her charge master for assisted living facility patients setup like this.

    90801 = Initial dx interview
    90804 = 20-30 min indiv therapy
    90806 = 45-50 min indiv therapy
    90808 = 75-80 min indiv therapy

    Is this correct or should we be using 90816, 90818, and 90821.


  2. #2
    assisted living is outpatient, correct? If so, then the dr's charge sheet is correct

  3. #3
    If an assisted living facility is categorized as outpatient. Then yes, it would be correct and that would be that. But, would it be better categorized as a residential care setting? Therefore, using the 90816, 90818, and 90821 code set.

  4. #4
    Assisted living is typically paid for from private funds, but there are a few exceptions. Some long-term care insurance policies cover licensed assisted living. In a limited number of states, Medicaid funds and waivers are available to help with assisted living costs.
    Assisted living is regulated at the state level. Because of that, every state has their own policies that define and regulate what care and services are required for an assisted living community to meet the state standards.
    I would check with Medicaid in your state and see how they categorize the service.
    Hope this helps

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