Author Topic: Psych billing and levels of care  (Read 557 times)

camedbill

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Psych billing and levels of care
« on: January 25, 2018, 12:46:56 PM »
We are currently billing for a psychiatrist with usual E/M 99212-5 and therapy add-on codes 90833-36 for outpatient. 
If a patient is at detox/residential level of care or partial hospitalization can we be bill using different codes or different place of service for higher reimbursement? If the suggestion is to change place of service, what is the POS for detox/residential.

Thank you in advance for your help

Michele

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Re: Psych billing and levels of care
« Reply #1 on: January 25, 2018, 07:47:13 PM »
The provider would have to be contracted with the insurance carriers as residential in order to bill for it, at least they do if they are in network.  It's not as simple as changing the POS.  Residential claims are billed on UB04 forms instead of CMS1500s. 
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camedbill

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Re: Psych billing and levels of care
« Reply #2 on: January 26, 2018, 11:10:27 AM »
Thank you for your response Michele.   
So the place of service I'm billing is Substance Abuse Rehabilitation Facility, would I be able to bill physician services on the UB04 and what revenue codes would I use on the UB04?
Or can I bill E/M codes 99233-99235 with POS 55 on CMS1500?
« Last Edit: January 26, 2018, 05:05:11 PM by camedbill »

camedbill

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Re: Psych billing and levels of care
« Reply #3 on: January 29, 2018, 12:03:01 PM »
Can Michele or anyone else help with this question?  Greatly appreciated

PMRNC

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Re: Psych billing and levels of care
« Reply #4 on: January 29, 2018, 02:12:20 PM »
Quote
The provider would have to be contracted with the insurance carriers as residential in order to bill for it, at least they do if they are in network.  It's not as simple as changing the POS.  Residential claims are billed on UB04 forms instead of CMS1500s.

You have not provided additional information, as Michele stated above..the provider would need to be contracted withe the carrier as a residential facility. You have not provided any add'l information beyond that to really help.
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Michele

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Re: Psych billing and levels of care
« Reply #5 on: January 30, 2018, 11:42:14 AM »
Thank you for your response Michele.   
So the place of service I'm billing is Substance Abuse Rehabilitation Facility, would I be able to bill physician services on the UB04 and what revenue codes would I use on the UB04?
Or can I bill E/M codes 99233-99235 with POS 55 on CMS1500?

Physician services would be billed on the CMS 1500 form.  You can use the POS 55.  If you are credentialed as a facility then the facility services would be billed on the UB 04.  If you are set up as a facility with the insurance carriers then you can bill as a facility.
« Last Edit: January 30, 2018, 11:43:52 AM by Michele »
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