Behavioral Health billed under PCP - Medicaid

[mokulicz]

Hi,
I am having trouble getting paid from Medicaid  for behavioral health billed under PCP , cpt codes: 99492, 99493 , T2022.
Any advice would be greatly appreciated.

[Michele]

There's not really enough information for me to help, but most likely the provider service type on file with Medicaid doesn't include those codes.  I would contact Medicaid and ask.  Without knowing the reason code (denial) and the specifics about the claim it's hard to be sure.

I'm really thinking that it's the way the provider is enrolled with Medicaid though.  For example if they enrolled as family medicine, or internal medicine, the behavioral health codes are most likely not in the "scope of practice" for those specialties. 

[mokulicz]

Dear Michele,
Thanks for your response . My providers contracts are in place for behavioral health.
This is one of our cases : patient came for first behavioral health visit on  01/15/2019 - provider spent with him 70 minutes. Then our social worker saw patient multiple times from 01/23/2019 to 01/31/2019 - total time spent with patient was more then 1 hour. I only billed 2 units , because I was told by dept of health that is all I can bill for. And also 99494 is  not payable by Medicaid anyway.

The first submission was:
01/15/2019-01/15/2019 - 99492  1 unit
01/23/2019-01/23/2019 - 99494  2  units
denial : N345 :  Date range not valid with units submitted.

Corrected Claim submission:

01/15/2019-01/22/2019  - 99492 1 unit
01/23/2019 -01/31/2019 - 99494 2 units
The latest denial that I received is:
N362 :  The number of Days or Units of Service exceeds our acceptable maximum.

When I call Medicaid - nobody wants to help

Any advise  how to bill this ?

[Michele]

99492 is "first 70 minutes in the first calendar month of BHCM activites" so it can only be billed for 1 date.  If the visit goes over 85 minutes then the 99494 should be used as well, on the same date.  So in looking at your first submission below it appears that 1/15/19 was the first date of activity and it was less than 85 minutes.  And then they had additional care on 1/23/19.  I believe you are supposed to report the care on 1/23/19 as 99492 for the first 85 minutes and then 99494 for the additional time, units would be depending on how long.  However, I am not a certified coder.  I got that information from:  https://www.aappublications.org/news/2017/11/02/Coding110217

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