Author Topic: How can I bill a 90806 & 90853 same day to Medicare  (Read 4475 times)

Lisa@srts-inc.com

  • Newbie
  • *
  • Posts: 25
    • Sophisticated Reimbursement and Transcription Solutions
How can I bill a 90806 & 90853 same day to Medicare
« on: February 02, 2011, 02:31:04 PM »
Hello,

I am trying to bill an individual therapy (90806) and a group therapy (90853) on the same day for the same patient to Medicare ( Massachusetts) but they are denying.  I tried to bill one visit with modifier 25 and still denied.

Any suggestions??

Thanks
Lisa
Lisa02184

rdmoore2003

  • Hero Member
  • *****
  • Posts: 631
  • Live Life and Love God
Re: How can I bill a 90806 & 90853 same day to Medicare
« Reply #1 on: February 02, 2011, 04:54:00 PM »
Is the rendering provider the same for both services?

camedbill

  • Jr. Member
  • **
  • Posts: 79
Re: How can I bill a 90806 & 90853 same day to Medicare
« Reply #2 on: February 02, 2011, 05:33:28 PM »
I don't believe you can bill two therapy codes on one day especially to Medicare regardless if same provider or not

rdmoore2003

  • Hero Member
  • *****
  • Posts: 631
  • Live Life and Love God
Re: How can I bill a 90806 & 90853 same day to Medicare
« Reply #3 on: February 02, 2011, 05:58:25 PM »
The only way that it could be done is if it is separate rendering providers under separate group numbers. 
But yes generally you cannot have two therapies in the same day.   you cant do 96101 and 96102 in the same day either.

Lisa@srts-inc.com

  • Newbie
  • *
  • Posts: 25
    • Sophisticated Reimbursement and Transcription Solutions
Re: How can I bill a 90806 & 90853 same day to Medicare
« Reply #4 on: February 02, 2011, 06:00:28 PM »
Yes, it is the same rendering.  The provider told me that the hospital she works for is able to do this but I never considered that they are probably billing the same patient but 2 different providers.

Thanks so much for the help.
Lisa
Lisa02184

Medical Billing Forum

Re: How can I bill a 90806 & 90853 same day to Medicare
« Reply #4 on: February 02, 2011, 06:00:28 PM »

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: How can I bill a 90806 & 90853 same day to Medicare
« Reply #5 on: February 03, 2011, 11:51:29 AM »
Also, if the hospital is billing for facility portion that would make a difference too.
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: How can I bill a 90806 & 90853 same day to Medicare
« Reply #5 on: February 03, 2011, 11:51:29 AM »