Author Topic: Modifier for Prolonged Therapy Session?  (Read 263 times)

Srsand

  • Newbie
  • *
  • Posts: 11
Modifier for Prolonged Therapy Session?
« on: May 12, 2021, 06:02:01 PM »
Hello all. I have a question and hope you all can help:
We have an insurance denying a prolonged therapy session that a clinical psychologist rendered. It was a 111 minute session. We billed a 90837 x 1 unit (53-89 minutes) with add-on code 99354 x 1 unit. Tricare is denying for "Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed". From what I can tell no modifier is needed. It was not a Telemed. Are they wanting the -HP? Or should we use -59 for this?
Thank you. 

kristin

  • Hero Member
  • *****
  • Posts: 682
Re: Modifier for Prolonged Therapy Session?
« Reply #1 on: May 12, 2021, 11:56:46 PM »
I can tell you this, they do not want a 59 modifier. 59 modifiers are never appended to any E/M code. They are strictly for procedures.

As I don't do any type of mental health/BH billing, I am not familiar with the HP modifier.

But I would absolutely appeal this denial any way you can.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 5862
    • Solutions Medical Billing
Re: Modifier for Prolonged Therapy Session?
« Reply #2 on: May 13, 2021, 10:18:56 AM »
I don't think the issue is a missing modifier.  Add on codes don't require them.  The 99354 is approved to use with the 90837 but they do not allow the first additional 1 - 29 minutes in addition to the 90837.  Since it was a 111 minute session, the 99354 should be allowed, but TRICARE may not allow for additional time.  I would recommend calling TRICARE to find out if it is a TRICARE exclusion, or if they require something indicating the amount of time spent. 

Also, if this was a crisis you may want to consider using crisis codes 90839 and 90840.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Srsand

  • Newbie
  • *
  • Posts: 11
Re: Modifier for Prolonged Therapy Session?
« Reply #3 on: May 14, 2021, 12:26:50 PM »
Okay. I'll have the denial called on for further reasoning. Thank you Kristin & Michelle!      :)

Medical Billing Forum

Re: Modifier for Prolonged Therapy Session?
« Reply #3 on: May 14, 2021, 12:26:50 PM »