Basic Physician Billing Question

[laurahartman]

Hi, I know DME billing as used to be a provider. I'm helping a friend with a new business and have a very basic question. For the CPT codes 99201-99215 for office visits, when submitting to Medicare, (assume same city) but different specialty, is the reimbursement the same? Or does Medicare "look at" the NPI/Taxonomy and pay more/adjust for specialties. For example private pay office visits for cardiologist is more than for PCP. Thanks so much!!!! I love this forum, read it all the time!

[Sriram_Sub]

Hi Laura! If it is same city, the rates for those office visit codes will not vary based on the specialty of the provider. It is standard across all type of providers.

[laurahartman]

Thanks so much! Wow, surprising though.

Laura

[Patricia Moore]

Hi, do anyone know if cpt code 90806, psych trmnt can be billed both on UB04 and 1500? We bill for facility charges as well as physician charges. The physician charges get paid, but facility charges are denied.

[PMRNC]

What kind of facility? the 90806 is a professional service code to be billed on CMS 1500. Not sure about facility since it's an office visit code technically.. I suppose it depends on what kind of facility.

[Patricia Moore]

We are a hospital. The Dr. bill for his services and hospital for use of facility. Dr. get paid and hospital charges on Ub04 are denied. The denials are usually, "duplicate".

[PMRNC]

Ah ok, because why would the carrier pay for therapy in a hospital setting and then turn around and pay for facility? Pretty sure that your not going to get both fees, only the professional component.

[QueenAlicia]

Isn't 90806 for a mental health or psychology practice?  One of my providers is a psychologists and that is what we bill often.

[Michele]

YOu can bill the 90806 on a UB04 but you have to have the corresponding rev code as well.  But I do doubt both will be paid.  The 90806 allows for the "facility".  Unless they reduced the allowance for the professional fee based on the place of service.

[PMRNC]

But I do doubt both will be paid.  The 90806 allows for the "facility".  Unless they reduced the allowance for the professional fee based on the place of service.

I have to ask.. what facility would charge a facility fee for psychotherapy?? I could see if therapy was part of an inpatient stay but not outpatient with facility charge, even your high end rehab centers where you go don't charge both!

[Michele]

We used to bill for a group that was considered a facility but they were actually a group of counselors (alcohol and Drug) who basically saw patients for therapy sessions, group and individual.  But the billing was done on a UB04 due to how the insurance carriers recognized them.  They billed for 90806 and 90853.  But they used rev codes that correspond to those CPT's.  BUT they did not bill the professional claims for the same sessions.  It's one or the other.