Medical Billing Forum

Coding => Coding => Topic started by: ukfiona on September 23, 2017, 09:41:28 AM

Title: Mental Health modifers
Post by: ukfiona on September 23, 2017, 09:41:28 AM
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?
Title: Re: Mental Health modifers
Post by: PMRNC on September 23, 2017, 01:27:32 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.
Title: Re: Mental Health modifers
Post by: Michele on September 25, 2017, 11:55:45 AM
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.

Title: Re: Mental Health modifers
Post by: Christy on September 25, 2017, 03:22:57 PM
Empire BCBS in New York pays the same for 90834 and 90837.   $80.
Title: Re: Mental Health modifers
Post by: Michele on September 26, 2017, 07:35:29 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!
Title: Re: Mental Health modifers
Post by: PMRNC on September 26, 2017, 09:56:20 AM
I have.. it's relatively new with EMPIRE and also UBH now..as recent as maybe July/August.
Title: Re: Mental Health modifers
Post by: Michele on September 26, 2017, 11:45:09 AM
How do they justify paying the same amount for 45 minutes and 60 minutes?
Title: Re: Mental Health modifers
Post by: Christy on September 26, 2017, 05:42:44 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)
Title: Re: Mental Health modifers
Post by: Michele on September 27, 2017, 12:46:36 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.