Wiki Behavioral Health Georgia - E/M Codes (99211-99215) w/Therapy (90832/34/37) - Mod 25

[rmw.wright@gmail.com]

Hi,

Is anyone familiar with Georgia CMO (Amerigroup, Peachstate, Wellcare and CareSource) billing of E/M codes 99211-99215 w and Ind/Fam Therapy on the same day?

It is hit or miss as to if the Ins Cos will pay for the above combination. I know each insurance company has it's own rules.

Any help is appreciated.

Thanks,

Michael

 

[Skymom]

This is from APA’s website:
I am a solo practitioner and generally see my patients for both E/M and psychotherapy on a weekly basis. Does the E/M code I bill limit the psychotherapy code I can bill?
No. The two services are separate. You code and document for whatever level of E/M is warranted by the patient’s presenting problem that day and select the add-on psychotherapy code based on the length of time of the psychotherapy provided. (The add-on psychotherapy codes are 90833 for 30 minutes, 90836 for 45 minutes, and 90838 for 60 minutes.) Since the current psychotherapy codes are not for a range of time, like the old ones, but for a specific time, the CPT “time rule” applies. If the time is more than half the time of the code (i.e., for 90832 this would be 16 minutes) then that code can be used. For up to 37 minutes you would use the 30-minute code; for 38 to 52 minutes, you would use the 45-minute code, 90834; and for 53 minutes and beyond, you would use 90837, the 60-minute code.