Author Topic: How to bill a 3 hour IOP group (90853) to insurance  (Read 4057 times)

MCMS

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How to bill a 3 hour IOP group (90853) to insurance
« on: April 07, 2009, 01:15:25 PM »
  I have been billing for 1 hour groups(90853) for a new chemical dependence office and they are now doing 3 hour groups 3 times a week.  Is there a modifier or another code to show they are now 3 hour groups and not 1 hour?  I tried to increase the units but it gets denied and only paid at the 1 hour rate. ???

Michele

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Re: How to bill a 3 hour IOP group (90853) to insurance
« Reply #1 on: April 09, 2009, 07:09:57 AM »
Since the CPT description doesn't specify a time frame the units would not be appropriate.  I'm not familiar with any way to bill a 3 hr session other than the 90853, but the allowed amount will always be low.  :(

Michele
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MCMS

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Re: How to bill a 3 hour IOP group (90853) to insurance
« Reply #2 on: April 09, 2009, 10:38:15 AM »
Thanks for the input Michelle  :) We did find a modifier -U2 or -U3 to show 2 or 3 hours so we are going to give it a try since the insurance co. are no help.....  So I'll make sure to give an update if that works.
Thanks, what a great forum! ;D
MCMS

Mystershyster

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Re: How to bill a 3 hour IOP group (90853) to insurance
« Reply #3 on: April 20, 2016, 03:24:05 PM »
When billing IOP, you need to use a UB10 form and bill rev code 0906 with 3 units to be properly reimbursed for it. Most providers group IOP and inpatient claims in the same category and therefore request facility claims for IOP to be billed on UB10 - when they transition to regular outpatient though, you need to go back to using the CMS10 forms..