Author Topic: 2011 CPT codes for Medicare  (Read 8521 times)

Leslie Bartley

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Re: 2011 CPT codes for Medicare
« Reply #15 on: June 03, 2011, 12:30:56 PM »
Several weeks ago I asked about a CPT code for Activity Therapy.  You said "I don't see a code specifically for activity therapy but there are codes for interactive psychotherapy (90810-90815)."  When I finally got my CPT Coding Book, I looked up these codes and they refer to individual psychotherapy.  Would these codes apply to a group setting of about 10 to 12 individuals?

Michele

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Re: 2011 CPT codes for Medicare
« Reply #16 on: June 04, 2011, 01:45:11 PM »
There does not seem to be any code specific to activity therapy in a group setting.  You will have to pick the cpt code that most closely describes the service you are performing.  I'm not sure how you could indicate that it was group as opposed to individual. 

Anybody have any insight on this??
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pattil88

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Re: 2011 CPT codes for Medicare
« Reply #17 on: June 04, 2011, 05:04:46 PM »
Leslie & Michele:
I was checking this out today and agree that this "Activity Therapy" is a very confusing billing scenario. All the documentation points to using G0176; however, the only billing references I find are to use this code in conjunction with revenue codes, which get billed to Medicare Part A and get paid to the facility. G0176 is not listed on any state's Medicare Part B Physician fee schedule, and the Medicare Master Fee Schedule lists this code with a status indicator "P" (Partial hospitalization; Paid under OPPS - Outpatient Prospective Payment System; Per Diem APC Payment).

Leslie, when you indicated that you had been granted a Medicare Provider Number, was that issued as your (physician) provider number? Or, could that have been a number assigned for the community mental health care facility to use on their billing?

I'll also keep an ear out on some other blogs to see if this issue has come up with any other providers.

Leslie Bartley

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Re: 2011 CPT codes for Medicare
« Reply #18 on: June 05, 2011, 10:00:41 AM »
Medicare granted us a provider number for our CMHC with Partial Hospitalization Program.  We are not yet approved for Medicaid services (Part A).

In reference to:

G0176 is not listed on any state's Medicare Part B Physician fee schedule, and the Medicare Master Fee Schedule lists this code with a status indicator "P" (Partial hospitalization; Paid under OPPS - Outpatient Prospective Payment System; Per Diem APC Payment).

We are a Partial Hospitalization Program.  The Medicare Contractor for Louisiana is Pinnacle Business Solutions in Little Rock Arkansas.   Looking in Medicare Part B, at their Physician Fee Schedule, entering G0176, G0177, G0410 and G0411; there is no payment for these codes.

Louisiana has started a Pre-Payment Probe Review for Group Psychotherapy.  We are a new company, having only recently submitted our first claims to Medicare.  I'm concerned that I have not used the proper codes.  In the light of the probe into Group Psychotherapy, even though it is for Part A - Medicaid; I need to have all my records and billing codes correct.

Any assistance would be appreciated.