Wiki Behavioral Health Facility Medicare billing guidelines

[billing@nphg.org]

Do I have anybody in here who is familiar with Behavioral health and billing Medicare on a UB04? I have a case where a client has a Medicare advantage policy and they are requiring certain rev codes along with a HIPPS code for pricing since we are an out of net work facility. I have been researching and have made several calls to get more direct information and I cannot figure it out, any help would be greatly appreciated!

 

[ckeeney]

What CPT codes?
WPS is our MAC, we are an Outpatient Hospital and Community Mental Health Center. We bill the following rev codes:
900 Psychiatric evaluation codes
914 Individual therapy codes
915 Group therapy codes
916 Family therapy codes
510 E&M office/outpatient codes

 

[billing@nphg.org]

Thank you for responding!
This is for Inpatient detox/RTC and PHP
126 detox inpatient
1002 res inpatient
913 PHP
All denied stating we are missing information, when I contact the insurance they state we are missing the HIPPS for pricing in box 44. I have spent several hours on calls with Insurance

 

[ckeeney]

We don't bill with HIPPS. In Box 44 we have a CPT code with the rev codes noted above for outpatient E&M and psych services. For rev 126 (which is rare for us) we have only the per diem rate in Box 44. We don't bill 1002 or 913 - PHP. I hope someone with HIPPS familiarity answers your question. You could also look at Noridian MAC and see if there is any help there. I have found their education/guides better than some of the other MACs and the CMS website (https://med.noridianmedicare.com/web/jea/provider-types/mental-health)

 

[billing@nphg.org]

We don't bill with HIPPS. In Box 44 we have a CPT code with the rev codes noted above for outpatient E&M and psych services. For rev 126 (which is rare for us) we have only the per diem rate in Box 44. We don't bill 1002 or 913 - PHP. I hope someone with HIPPS familiarity answers your question. You could also look at Noridian MAC and see if there is any help there. I have found their education/guides better than some of the other MACs and the CMS website (https://med.noridianmedicare.com/web/jea/provider-types/mental-health)

I hope so to, this has been so frustrating trying to figure out. I appreciate your responses

 

[billing@nphg.org]

I hope so to, this has been so frustrating trying to figure out. I appreciate your responses

We don't bill with HIPPS. In Box 44 we have a CPT code with the rev codes noted above for outpatient E&M and psych services. For rev 126 (which is rare for us) we have only the per diem rate in Box 44. We don't bill 1002 or 913 - PHP. I hope someone with HIPPS familiarity answers your question. You could also look at Noridian MAC and see if there is any help there. I have found their education/guides better than some of the other MACs and the CMS website (https://med.noridianmedicare.com/web/jea/provider-types/mental-health)

Do you bill on the UB 04 claim and do you bill your inpatient as interim?

 

[ckeeney]

Do you bill on the UB 04 claim and do you bill your inpatient as interim?

We bill inpatient (that may include SUDS) on a UB. I have done interim claims but this does not happen very often for us since we are mainly psychiatric inpatient and not SUDS rehab. Most of my facility's services are outpatient hospital and split billed on 1500's/UB's.