Payments > Insurance Payments
BLUE CROSS BLUE SHIELD
rdmoore2003:
Here is my clarification on this: my medical psychologist can bill e/m codes, with and without add on codes, for every insurance that we are paneled with except medicare and tricare. tricare requires 90863 with therapy add on. (example: 90863 & 90832).
None of our paneled insurance will except the M0064, this is only for psychiatrists. (per our paneled insurances here)
Now, this is per our contracts, fee schedules, etc. It is all in writing and I have not had any issues all year with payments or denied claims. It was nerve racking at first because there is only 2 states that have this type of provider. It is simple and the APA and State board does have guidelines for this that you can get.
rdmoore2003:
including blue cross blue shield
PMRNC:
If you look at some of your contracts.. let's take Value Options for example, they actually sent providers clarification on using M0064 and their allowance was for "prescribers". HOWEVER this still wouldn't help you even if you could bil lit UNLESS the patient was coming in ONLY for a med check. Your issue is that BCBS is following Medicare rules and many DO that using Medicare as the base guideline. In any other state your provider wouldn't be doing E/M or medication mgmt at all. The issue is that the scope of license is recognized, but the carriers still can determine if they want to pay a med mgmt code WITH therapy on same date. If you were in any other state OR if your provider was a psychiatrist you would have no problems with the E/M and add on's. JMHO but if I was in your position I'd have my provider / client refer out for med checks as they are losing reimbursement due to the restrictions and coverage guidelines.
Sophrosyne:
Thanks for all the advice! I just recently received an email from BCBS saying: "Effective January 1, 2014, BCBSLA will allow payment for E&M codes and the following psychotherapy codes when billed on the same claim: CPT codes 90833, 90836, 90838." They don't say anything about same date of service, but we'll see how it goes!
PMRNC:
Thanks for all the advice! I just recently received an email from BCBS saying: "Effective January 1, 2014, BCBSLA will allow payment for E&M codes and the following psychotherapy codes when billed on the same claim: CPT codes 90833, 90836, 90838." They don't say anything about same date of service, but we'll see how it goes!
Is that for LA medical psychologists? That is basically your problem. For my psychiatrists we are getting paid for the E/M and therapy codes.
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