Coding > Coding
2011 CPT codes for Medicare
Leslie Bartley:
I am a partner for a new community mental health center - partial hospitalization program. We will electronically bill only Medicare claims. We have been granted a Medicare provider number.
We are starting to bill Medicare electronically for the services and procedures we provide. We have almost got our CMS 1500 template completed, but we are having problems with line 24F - Procedures, Services & Supplies. Through our Psychiatrist's Office we contacted other providers who are using our psychiatrist and offer the same services that we do. They said that they use the HCPCS codes G0176 (revenue code 0904) for Activity Therapy, G0177 (revenue code 0942) for Patient Education and G0411 (revenue code 0915) for Group Therapy. When we contact Pinnacle Medicare (Louisiana) they direct us to their website. When we enter the codes into the Physician Fee Schedule It tells us that there is no such code found.
When we called Pinnacle Medicare for an explanation they said that using these codes would result in denied claims. They said that we had to use CPT codes, but could not direct us to the codes we need to use. I have ordered a CPT coding book, I searched the internet, and I ordered all of Medical Billing's books in the hope that I could get some direction.
I found this article on the internet when looking up codes: CMS Manual System - Pub 100-04 Medicare Claims Processing. Centers for Medicare & Medicaid Services (CMS), Transmittal 2141, Date: January 24, 2011, Change Request 7271. This manual indicates that Medicare will pay for the above HCPCS codes. I'm totally confused.
Gateway, EDI are scheduled to run a test on several claims tomorrow. I can't submit any claims until I can find the proper service codes.
Thank You for Your Help;
Leslie E. Bartley, Ph.D.
We are not in a position to hire a medical biller, therefore, it falls to me to work this out.
We urgently need to begin submitting claims, but I don’t want to have them rejected.
Michele:
Leslie,
I think you are looking for CPT codes 90801-90899.
I don't see a code specifically for activity therapy but there are codes for interactive psychotherapy (90810-90815). The code for group therapy is 90853. I don't see a code specifically for patient education either, but there is a code for unlisted procedure - 90899.
I hope that helps. Please post back if you need more info.
Leslie Bartley:
Thank You for this information. We have spent two weeks looking for these codes. Are there any modifiers that should go with these codes, like the one for unspecified procedure?
Michele:
Not any specific modifiers for mental health codes. None for the unlisted one but expect to have them request a description of services. In fact include one with the claim!
Leslie Bartley:
Thanks for this wonderful advice. When submitting an explanation for an unlisted procedure, where do you put it for an electronic claim?
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