ali2gark
Guest
Trying to get an LCSW to provide in home psychotherapy/counseling to a patient who is covered by Cigna primary and Medicare secondary. Cigna advises that they do not accept CPT codes 90791 or 9083x for in home psychiatric assessments or psychotherapy and advised me to utilize E/M codes 99341-99350 as applicable. However I thought LCSW cannot bill E/M and asked Cigna's rep about this, she stated those codes covered LCSW services in home. Anybody know if this is true?
Then, as I was reviewing the CPT codebook in my research, it states under Home Health procedures that there are separate codes 99500-99600 to be reported by non-phsycian health care professionals (LSCW?) and that physicians should utilize the home visit codes 99341-99350 and NOT use the 99500-99600 codes for additional procedures. It states that health care professionals who are authorized to use E/M 99341-99350 can report the 99500-99600 in addition to the E/M 99341-99350 if both services are performed. E/M services may be reported separately using mod. 25 IF a separate identifyable E/M svc above and beyond the home health service.
Can the 99500-99600 codes be billed as standalone services? Or they are only to be used with the E/M?
I'm SO CONFUSED. Does anyone know what is the correct way to do this? I'm pretty sure it will be denied due to the practitioner license level if I submit the E/M codes 99341-99350 for LCSW even though the Cigna rep stated to. It sounds like the correct code is 99510 Home visit for individual, family or marriage counseling is the one I would need but I don't know if I can bill that on it's own.
To further complicate my questions, is there any indication that Medicare as secondary pays on this type of visit?
I'm currently on hold with Cigna to specifically inquire about this but any help or experience you all could lend would be so greatly appreciated.
EDIT**CIGNA RESPONDED**that this LCSW has the E/M codes 99341-99350 in his contract and they are billable, covered services. They also state the 99510 code doesn't even come up as a service so it's definitely not covered. Now my question is, will Medicare accept the E/M codes when secondarily billed? I'M STILL SO CONFUSED
Then, as I was reviewing the CPT codebook in my research, it states under Home Health procedures that there are separate codes 99500-99600 to be reported by non-phsycian health care professionals (LSCW?) and that physicians should utilize the home visit codes 99341-99350 and NOT use the 99500-99600 codes for additional procedures. It states that health care professionals who are authorized to use E/M 99341-99350 can report the 99500-99600 in addition to the E/M 99341-99350 if both services are performed. E/M services may be reported separately using mod. 25 IF a separate identifyable E/M svc above and beyond the home health service.
Can the 99500-99600 codes be billed as standalone services? Or they are only to be used with the E/M?
I'm SO CONFUSED. Does anyone know what is the correct way to do this? I'm pretty sure it will be denied due to the practitioner license level if I submit the E/M codes 99341-99350 for LCSW even though the Cigna rep stated to. It sounds like the correct code is 99510 Home visit for individual, family or marriage counseling is the one I would need but I don't know if I can bill that on it's own.
To further complicate my questions, is there any indication that Medicare as secondary pays on this type of visit?
I'm currently on hold with Cigna to specifically inquire about this but any help or experience you all could lend would be so greatly appreciated.
EDIT**CIGNA RESPONDED**that this LCSW has the E/M codes 99341-99350 in his contract and they are billable, covered services. They also state the 99510 code doesn't even come up as a service so it's definitely not covered. Now my question is, will Medicare accept the E/M codes when secondarily billed? I'M STILL SO CONFUSED
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