Author Topic: Mental Health modifers  (Read 2932 times)

ukfiona

  • Newbie
  • *
  • Posts: 1
Mental Health modifers
« on: September 23, 2017, 12:41:28 PM »
With the new BCBS contracts in Florida, the reimbursement rate for 90834 and 90837 are now the same at $70. I have been asked to look into using modifier codes to be more specific and possibly get paid more. Any ideas?

PMRNC

  • Hero Member
  • *****
  • Posts: 4562
    • One Stop Resources & Networking for Medical Billers
Re: Mental Health modifers
« Reply #1 on: September 23, 2017, 04:27:32 PM »
Quote
With the new BCBS contracts in Florida, the reimbursement rate for 90834 and 90837 are now the same at $70. I have been asked to look into using modifier codes to be more specific and possibly get paid more. Any ideas?

Billing a modifier to boost reimbursement higher wouldn't be appropriate at all as the rate isn't going to increase for these types of service with any modifier.  Carriers also usually will not pay more than one therapy (group or individual) per day.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Mental Health modifers
« Reply #2 on: September 25, 2017, 02:55:45 PM »
Ditto to what Linda said.  But I find it odd they pay the same amount for the 90834 and the 90837.  I would double check to see if that is correct.

Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Christy

  • Sr. Member
  • ****
  • Posts: 320
Re: Mental Health modifers
« Reply #3 on: September 25, 2017, 06:22:57 PM »
Empire BCBS in New York pays the same for 90834 and 90837.   $80.

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Mental Health modifers
« Reply #4 on: September 26, 2017, 10:35:29 AM »
Empire BCBS in New York pays the same for 90834 and 90837.   $80.

Really?  Wow.  We bill a lot of mental health and I don't believe we've ever come across that.  We do run across plans that don't allow the 90837 but not with the same allowable rates. 

Ya learn something new every day!
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Medical Billing Forum

Re: Mental Health modifers
« Reply #4 on: September 26, 2017, 10:35:29 AM »

PMRNC

  • Hero Member
  • *****
  • Posts: 4562
    • One Stop Resources & Networking for Medical Billers
Re: Mental Health modifers
« Reply #5 on: September 26, 2017, 12:56:20 PM »
I have.. it's relatively new with EMPIRE and also UBH now..as recent as maybe July/August.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Mental Health modifers
« Reply #6 on: September 26, 2017, 02:45:09 PM »
How do they justify paying the same amount for 45 minutes and 60 minutes?
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Christy

  • Sr. Member
  • ****
  • Posts: 320
Re: Mental Health modifers
« Reply #7 on: September 26, 2017, 08:42:44 PM »
Empire BCBS - it's been at least 3 years that 90834 and 90837 pay at the same rate (for LCSWs & LMHCs)= $80

also MVP and NYSHIP via Value Options (now called Beacon Health Options) pay the same for 90834 and 90837-   MVP- $60 and NYSHIP $67  (LCSW & LMHC)

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Mental Health modifers
« Reply #8 on: September 27, 2017, 03:46:36 PM »
We have some carriers that will not reimburse for the 90837 but we haven't seen the same allowables.  I will have to check some eobs to verify.  I don't handle them day to day anymore.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Medical Billing Forum

Re: Mental Health modifers
« Reply #8 on: September 27, 2017, 03:46:36 PM »