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CORRECT FL BLUE OUTPATIENT DETOX CODES

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WhitanyaS:
Hello all,

I have received denials from FL Blue for outpatient detox for incorrect biling. They were initially billed on a HCFA with CPT code S9475. The payments were painfully low. As a project, I have been advised to rebill about $300k worth of claims on a UB-04 H0014/0944. They are denying to incorrect billing but i do not see any other codes I can use.

It facilities is a free-standing facility with Taxonomy 261QR0405X - Clinic/Center: Rehabilitation, Substance Use Disorder. Any advisement would be greatly appreciated.

Thank you,

Whitanya

Michele:
Are you billing for the facility charges or the professional fees?  Are you credentialed with FL Blue as a facility?

WhitanyaS:
Good morning,

Thanks for responding!

We are credentialed as a facility with FL Blue and are billing per diem rates because of that (as opposed to ancillary professional services).

Michele:
If you are credentialed as a facility shouldn't you be billing on the UB04 at the per diem rates?

WhitanyaS:
Hello,

Yes, one think so but we are being told by FL blue the 0944 is not in their fee-shcedule and it, therefore, no payable. The only other possible codes to use (that i could find) is 0900, which is general behavioral health, and 0520, which is Free-standing clinic, general. Any thought?

Thanks

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