Wiki CPT vs. HCPCS

[Merrylb]

Our office provides MH assessments which we normally bill as 90791 but our billing office wants to bill these out as H0031 because it is paid out at a higher rate. Another example would be using H0004 behavioral health counseling and therapy instead of the appropriate CPT code for therapy. Is it acceptable to use the HCPCS equivalent of a CPT code just because certain payers will pay more for it?

 

[jkyles]

Hello,
You'll need to report what's supported by the documentation. In addition, those codes aren't equivalent. For example:

90791 Psychiatric diagnostic evaluation
H0031 Mental health assessment, by non-physician

 

[jbhuju]

do we need to add modifier on H0004/H0031 ?

 

[OpenClaims]

90791 and H0031 are not equivalent to one another. In addition, H0031 is payor specific, so be sure to look into insurance types prior to billing, if you choose to use that code.