Author Topic: ABA Therapy  (Read 1289 times)

Missjay

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ABA Therapy
« on: October 17, 2016, 12:55:35 PM »
I am new to billing for ABA Therapy and was wondering if anyone was familiar with billing T codes... 0364T & 0365T? I am getting denied by BCBS stating they are mutually exclusive.

Any help would be appreciated...


Thanks

Michele

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Re: ABA Therapy
« Reply #1 on: October 18, 2016, 08:15:26 AM »
That doesn't sound right.  The 0364T is for the first 30 minutes and the 0365T is for each additional 30 minutes.  How can each additional 30 minutes be inclusive of the first 30 minutes?  I'm not a  certified coder but that seems wrong.  Have you called to speak to anyone about the claim?  I would start with calling the customer service department and asking them to explain the denial.
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Missjay

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Re: ABA Therapy
« Reply #2 on: October 19, 2016, 09:27:24 AM »
Yes I called and they stated that 0364T & 0365T(Behavior Health) along with 92507(Speech Therapy) cannot be billed on the same DOS. It doesn't make sense because it is two different therapist with different NPI's.

Michele

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Re: ABA Therapy
« Reply #3 on: October 19, 2016, 08:41:19 PM »
I'm confused.  Your original post stated that you were having an issue with 0364T & 0365T being denied stating mutually exclusive.  Are you talking about the 92507 and the 0364T/0365T being an issue?  Or just the 0364T & 0365T?  I responded to your other post regarding the ST & BH.  Just to summarize, if they are in the same group that may be the issue (even with their own individual NPIs).  But if they are not in the same group then it may be a plan exclusion.  I would ask specifically if it is a plan exclusion or if it is because they are in the same group.  Also ask if it can be appealed. 
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Missjay

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Re: ABA Therapy
« Reply #4 on: October 21, 2016, 10:59:04 AM »
Yes sorry I forgot to mention they were stating it was mutually exclusive because of the T codes and 92507 being billed by the same provider on the same DOS. The Provider is a BCBA and SLP and the services are completely separate. I've pretty much decided that I am going to submit an appeal with clinical and have them review it.