Author Topic: Medicare Alcohol Treatment Coding  (Read 2493 times)

BRPrvn

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Medicare Alcohol Treatment Coding
« on: November 17, 2011, 05:26:04 PM »
We had a patient come in for partial hospitalization and an intensive outpatient treatment program for alcohol. They had a Health Net plan and we obtained precertification for the treatment. The claims recently denied as "not a covered service" due to the policy being a Medicare replacement plan which neither the patient or insurance told us about. The insurance is saying the codes are not covered by Medicare. We don't take Medicare and are unfamiliar with Medicare facility codes for MH and substance. The revenue codes for partial and IOP are 0912 and 0906 respectively and the HCPCS are H0035 and H0015 both of which are being denied. Although the insurance plan and the Medicare billing manual say substance abuse treatment is covered, we can't find anyone who knows the actual codes Medicare uses. Would any one here in this forum be familiar with these Medicare codes? Thank you.
Reiner N.
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Benefit Recovery Partners

Michele

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Re: Medicare Alcohol Treatment Coding
« Reply #1 on: November 17, 2011, 06:50:55 PM »
I believe the problem is not with the codes but with the fact that Medicare does not cover the services.  I believe the denials are being triggered by the diagnoses which you can't change.
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BRPrvn

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Re: Medicare Alcohol Treatment Coding
« Reply #2 on: November 18, 2011, 11:56:40 AM »
Thank you for your reply Michele. This one may end up being a big write off!
Reiner N.
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Benefit Recovery Partners

PMRNC

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Re: Medicare Alcohol Treatment Coding
« Reply #3 on: November 18, 2011, 04:18:32 PM »
I don't see where you have to write anything off. I do think it was responsibility of the patient to give you proper information up front. I don't know who did precert and eligibility check but it's something that might also have been caught then since you can tell just by the insurance card itself, even then I still don't think this would be something I wrote off.
Linda Walker
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billinggirl

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Re: Medicare Alcohol Treatment Coding
« Reply #4 on: December 29, 2011, 07:07:05 PM »
I was researching last night and Medicare does cover the services. I saw it on CMS.gov you might want to take a look its under 2011 codes for substance abuse and mental health services....

PMRNC

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Re: Medicare Alcohol Treatment Coding
« Reply #5 on: December 31, 2011, 11:18:14 AM »
I have not looked to see if it's covered, but just because they have guidelines for billing something it doesn't mean it's covered.  Personally I've not run into billing substance abuse for Medicare but I'm not sure why they wouldn't cover it.
Linda Walker
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www.billerswebsite.com