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BLUE CROSS BLUE SHIELD
rdmoore2003:
bcbs is not covering 90863
PMRNC:
Because med management code 90862 was deleted prescribing providers instead needed to use the E/M code. IN Your situation(s) your prescribing provider is a psychologist in one of the two states that allow them to prescribe, however they cannot bill E/M codes.. With that in mind what if you billed your psychotherapy code along with HCPCS M0064. M0064 is used by those provider's performing a quick med check, it cannot be billed with any E/M service and is meant to just be a code used when only a small portion (general rule is 15 min or less) of the visit is for medication management/prescription.
Just a thought. I have psychiatrists who use this code since Medicare began cracking down on Nursing home visits for 90862.
rdmoore2003:
--- Quote from: PMRNC on November 06, 2013, 11:32:30 AM ---Because med management code 90862 was deleted prescribing providers instead needed to use the E/M code. IN Your situation(s) your prescribing provider is a psychologist in one of the two states that allow them to prescribe, however they cannot bill E/M codes.. With that in mind what if you billed your psychotherapy code along with HCPCS M0064. M0064 is used by those provider's performing a quick med check, it cannot be billed with any E/M service and is meant to just be a code used when only a small portion (general rule is 15 min or less) of the visit is for medication management/prescription.
Just a thought. I have psychiatrists who use this code since Medicare began cracking down on Nursing home visits for 90862.
--- End quote ---
Medical psychologists can bill E/M codes. Medical psychologists cannot use the M code
rdmoore2003:
--- Quote from: rdmoore2003 on November 05, 2013, 07:45:46 PM ---bcbs is not covering 90863
--- End quote ---
for medical psychologists that is
PMRNC:
I should have clarified.. Medical psychologists cannot bill E/M codes to MEDICARE. Remember MOST carriers follow Medicare, hence BCBS won't allow you to bill the E/M for this provider. Their licensure requirements for prescribing does not include evaluation and management..
Psychologists cannot bill Evaluation and Management (E&M) codes when treating Medicare beneficiaries because the Center for Medicare and Medicaid Services (CMS) currently restricts the use of these codes. CMS has taken the position that E & M codes involve services unique to medical management, such as medical diagnostic evaluation, drug management, and interpreting laboratory or other medical diagnostic studies.
Although there are some similarities among the services, the health and behavior codes should not be viewed as a substitute for E&M codes. APA is continuing its advocacy with CMS to permit psychologists to be reimbursed for providing E&M services to Medicare beneficiaries.
Psychologists treating patients with private insurance may be able to bill for E&M services because not all insurers impose the same restrictions as Medicare. Psychologists should check with the private carrier to determine its policy on E&M services. -- Source APA
M0064 can be used in lieu of the old 90862, however it is for the "soul purpose of monitoring....." and you wouldn't be able to bill it with psychotherapy.
I think it's important to remember there are ONLY two states right now that allow specialty licenses to psychologists for the purpose of prescribing So this is one of those things those two states have to deal with. There won't be allowances for med management on same day with separate reimbursement. Since BCBS follows Medicare guidelines that is why you will receive the denials and I can't see a way around it because you can't bill the E/M. If you could your problem is solved as you would use the medical evaluation mgmt code with your add on therapy code, but again, you can't do that due to the type of provider.
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