Wiki Medicare benefit

[greatbiller]

Hello coders, and happy Monday.

I do not deal with behavioral health on a regular basis, so I apologize in advance if this issue has been previously addressed.

I am working Medicare claim denials, and I understand that H2012 is not a payable service under Medicare, but there is a notation that Medicare requires a different code for this service. I have not found a definitive answer as to what the code is.

Is anyone able to help me out? Thank you in advance for your assistance, and have a great week!

Patricia Murrin, CPC, RCC

 

[greatbiller]

Clarification

To clarify my prior post, I am working a denial on the facility side, not the physician side.

Again, thank you in advance!

Patricia Murrin, CPC, RCC

 

[Cavalier40]

What level of care are they receiving and under what rev code are you billing?

 

[greatbiller]

Outpatient behavioral health, bill type 131, revenue code 915. Patient participating in multiple group therapy sessions per day.

Thank you for taking the time to help me with this! It is greatly appreciated!!!

 

[Cavalier40]

I would bill with CPT 90853 (outpatient group therapy) and Rev code 0915. Normally I would bill as an all inclusive per diem, however I remember being told once that you can bill up to 3 groups per day.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r167cp.pdf

this is a good resource for UB billing and clarifies questions about bill type code.

Hope this helps