Medical Billing Forum

General Category => General Questions => Topic started by: Angie on October 07, 2011, 10:14:28 AM

Title: Group Therapy
Post by: Angie on October 07, 2011, 10:14:28 AM
We are a licensed "Therapeutic Wilderness Program" and while 99.9% of the insurance companies does not cover Wilderness Programs they often will reimburse their members for a portion of the therapy sessions that are provided directly by the licensed therapist when the therapist is in the field and holds a face to face individual session, group session ect....
My question is: The students/clients have a group session everyday whether it is a recreational group or a group related to topic they are discussing that week. These groups are not provided directly by the therapist as the therapist is not in the field 7 days a week but held by the field staff (who are not licensed therapists) that the therapist has given direction. I have families asking daily why we cannot prepare a statement with codes for these sessions; which I know the answer to that because they are not licensed therapists holding the groups. Is there any other codes that anyone knows of that we could use to provide a statement to our families for these groups? The staff keeps notes of the groups that were held while the therapist are not in the field but I am just not sure there are any codes that we could use ethically? We are private pay and are not contracted with any of the insurance companies and do not accept any insurance payments but will provide a superbill when requested by the parents so they can try to seek some sort of reimbursement from their insurance company.
Title: Re: Group Therapy
Post by: Michele on October 07, 2011, 05:49:35 PM
The code for the group therapy would be the same, the problem is that the rendering provider is not a covered provider.  So if the claim were filed correctly it would have the name, credentials and individual NPI of the field staff.  So the claims should be denied as services rendered by a non covered provider.  If they insist on receiving a statement you can give them the statement showing the group therapy session but include the provider as the field staff member who oversaw the therapy.