Author Topic: ABA coding w BCBS of TX  (Read 1173 times)

abaclaims

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ABA coding w BCBS of TX
« on: June 05, 2015, 04:47:55 PM »
I bill for ABA therapy and am running into issues with BCBS. Anyone else having success billing and being paid accurately for services provided at a Masters/BCBA level?

kristin

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Re: ABA coding w BCBS of TX
« Reply #1 on: June 05, 2015, 05:22:12 PM »
I don't bill that, but have you read the medical policy for ASD for BCBS/TX? It specifically addresses ABA Therapy in it. Not sure if this will help or not, but here you go:

http://www.medicalpolicy.hcsc.net/medicalpolicy/activePolicyPage?lid=hyo9o6mz&corpEntCd=TX1

abaclaims

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Re: ABA coding w BCBS of TX
« Reply #2 on: June 08, 2015, 02:46:22 PM »
thanks, interesting info. It does list codes and the code we use is shown (96152) - however it appears that they are paying the claims at the standard level, despite the addition of the HO Modifier which should considerably affect the rate at which the claim is paid. Any experience with the modifiers? Seems that BCBS is completely disregarding them. Perhaps they have specialized processes for modifiers different than other insurance?