Understanding Modifiers for Mental Health Billing

The codes communicate to payers what procedures you need to be reimbursed for as a provider. If you know the available coverage for every patient before you provide services, it will be much easier for you to submit proper claims and minimize frustration for you and your patient. This may take some additional time on your part, but it will be worthwhile when you can avoid common mistakes. If you want to check your patient’s coverage, you can perform a verification of benefits (VOB). This procedure will give you a better idea of your patient’s insurance plan and provide them with treatment and services accordingly.

You can’t bill payers for a diagnosis, but you can bill them for your treatment services. When these services are billed to health insurance, it is often a simple task because routine checkups are frequently under one general charge. There is a wide range of factors that contribute to the differences in these services.

These 6 physician specialties have the most burnout

These codes, which are always five digits, pertain to mental health testing, assessment, psychiatry evaluation and management, case management, and telehealth. Our fully templated EHR offers many different features that can benefit you and your patients, such as patient portals, charting and automatic coding. Whether you work in an inpatient or outpatient setting, ICANotes can simplify your daily processes with our mental health billing solutions.

Diagnosis coding allows mental health professionals to identify different treatments, diagnoses or actions given to the patient. Diagnosis coding is documented to make it easier to categorize different mental disorders or diagnostic evaluations during therapy. Insurance companies need to see that the patient has a clear diagnosis that is medically necessary and qualifiable for covered mental health insurance. Modifiers play a crucial role in mental health billing, ensuring accurate reimbursement, reducing claim denials, and facilitating effective communication between providers and payers. Mental health professionals and billing specialists must understand the purpose and proper usage of modifiers to comply with coding guidelines and optimize reimbursement for their services.

We handle your insurance billing

If you are struggling to do each of these tasks for your insurance clients, considering hiring a mental health billing service like TheraThink to solve these problems for you. Overall, Medicare Part C typically covers health care needs https://www.bookstime.com/articles/how-to-calculate-burn-rate-for-your-business beyond what Original Medicare covers. For many plans, this may include transportation to and from appointments and special needs plans (SNP) that may offer coverage for mental health treatment that is not covered by Parts A and B.

Usually, only state run Medicaid programs require the use of license level modifiers for mental health claims based on your degree, but check with each insurance company you’re billing with to be sure. mental health billing Enter your zip code above to find mental health insurance and Medicare plans that may be available in your area. Medicare Part B covers a variety of outpatient mental health treatment services.

Complete Guide to Mental Health Billing

Psychotherapy for crisis; each additional 30 minutes (list separately in addition to code for primary service). Other Information CPT codes 90885, 90887, are considered incidental services and are not separately payable. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. If you want to learn more about how to get back to what matters most – your patients – schedule a free financial health checkup with Coronis Health.

While precision in how you use CPT codes may not seem of utmost significance, in fact, using the correct CPT codes for the mental health services you provide is important for two major reasons. When your claims include the right codes, they’ll be accepted in a more timely manner, ensuring you have the necessary cash flow to operate your practice. Perhaps more urgently, coding mistakes could cause your practice to be audited, and errors could result in fines. In this post, we’ll cover what you need to know about using CPT codes and the most common codes you should become familiar with. As with any mental and behavioral health industry procedure, it doesn’t hurt to double-check yourself.

Does Medicare Cover Mental Health?

Many health insurance plans also require pre-authorization, which means that patients must get permission before receiving coverage for some mental health services. This procedure can prolong insurance billing and prevent a patient from receiving the treatment they need. Mental healthcare providers can also become frustrated with medical billing because of the lack of resources.

Research conducted by the American Psychological Association (APA) shows that 15 to 20 percent of Americans 65 and older have experienced some degree of depression. Get timely coding industry updates, webinar notices, product discounts and special offers. This is another area where we recommend contacting or researching ahead of time before filing a claim. The standard is generally 02 but varies depending on the insurer and plan. With the onset of coronavirus in 2020, the coding standards for Telehealth have been changing and getting updated faster than ever.

— Psychotherapy, 60 minutes

Many private practices are small and have limited administrative support to help with the task of medical billing — which can lead to unintentional errors and overworked physicians and therapists. Essentially, an incomplete or inaccurate medical record would reflect that medical and mental health services are unnecessary for the patient. This error often results in insurance companies not paying for the service, making it difficult for behavioral health providers to do their job and patients to get the treatment they need. Proper note writing and documentation also play a huge role as a communication tool used between mental health providers and professionals. One or more of these problems — and many other variables — can make it difficult for mental and behavioral health providers to operate their practice efficiently. A lot of time and energy goes into filing a claim with medical billing for mental health services, taking away time from patients.

• There has been significant back and forth between coding Telehealth visits with 11 and 02 (the place of service code for Telehealth).
• You can’t bill payers for a diagnosis, but you can bill them for your treatment services.
• The AMA assumes no liability for data contained or not contained herein.
• No matter your field, all providers must complete the proper medical documentation, explain the medical need for services rendered, and submit clean claims to insurance companies.
• Psychiatric Diagnostic Procedures may be reported once per day and not on the same day as an evaluation and management service performed by the same individual for the same patient.
• The evaluation may include communication with family or other sources and review and ordering of diagnostic studies.
• You will certainly want to file your claim within that window of time, or you run the risk of a prolonged claims process.