Medical Billing Forum

Billing => Billing => Topic started by: laceyx08 on October 26, 2012, 10:11:55 PM

Title: 90801
Post by: laceyx08 on October 26, 2012, 10:11:55 PM
Just a quick question about the 90801 CPT. I have a psychologist who said he heard you can bill a 90801 three times in a row before you have to bill for the subsequent visits. I have never heard this. Anyone else?
Title: Re: 90801
Post by: PMRNC on October 27, 2012, 08:27:32 AM
Generally, you can bill one 90801 per provider (linked to tax ID number) per condition (icd-9), per setting, per duration (for Medicare duration is 12 months).  However there are some carriers that flat out won't pay for more than one 90801 within 12 months at all.   

90801 and 90802 are gone as of 1/1/2013   
Title: Re: 90801
Post by: laceyx08 on October 27, 2012, 09:05:52 AM
Yeah I heard about the code changes. Thank you for the answer. Maybe someone could help me with this as well. He's only participating with blue cross and just sees all the rest as out of network. So I would put "no" for accept assignment for all of the insurance carriers except blue cross right? My other clients are participating with most insurances so this is kind of new to me.
Title: Re: 90801
Post by: Michele on October 30, 2012, 07:53:31 AM
I have seen a FEW minor insurance plans that have allowed a provider to bill more than 1 90801, but in the cases I saw they could only bill 2 in a row.  Not sure what the logic was and it was only one plan.  Dr told me that they allow him 2 sessions to do initial evaluation to determine dx.  Actually I can see with some very involved cases where that can be needed.  Hard to get to the bottom of 30 yrs of depression, etc, bad childhood, and more in one session.  Can be overwhelming for the patient.  But most carriers do not allow it.  Linda's info is correct.  I just wanted to mention that I have seen it allowed but on a very limited basis.  It may have been something that the provider negotiated in their contract??