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Billing Psych visit 90834 to Medicare for denial - confused about GY modifier

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debfini:
Hello everyone - have been billing psych for 20 years and just now finding out information regarding billing Medicare for an Licensed Professional Counselor (LPC) - which is NOT covered my Medicare in Virginia.  I always send these via paper with letter stating that Medicare does not pay for services rendered by LPC - please deny and highlight on bottom of claim "This claim is for denial purposes only" (which is what Medicare told me to do years ago)... :-\  Then I submit denied EOB to secondary. 

Think I have been doing this wrong all along?  Should I be sending the HCFA to Medicare without letter, etc? And, instead send the HCFA with just a "GY" modifier?  With Psych - I have never used a modifier.

Please advise.. :-[.  Also I just saw that Medicare will not take the OLD HCFA's after 4/1/14.

Thanks to anyone that can guide me....

Debbie

rdmoore2003:
Medicare does not cover LPC's.   Why are you using a modifier?    If I have a patient that has medicare primary, I file to medicare electronically so that they can send crossover. 

Merry:
It only will cross over for Medigap plans.  Many secondaries are supplementals, which dont always cross over. 
More so.. If the specialty is not a covered benefit for Medicare how can one  even attempt to bill Medicare?  I am confused.  The provider would not be in the Medicare system at all.  Ok,  missing part of my brain here. 

debfini:
Merry and Rdmoore - This provider is not set up electronically because she is (opt-out) and because Medicare does not pay for LPC....so I do it all by paper.  I read this information on Medicare website and started second guessing myself as Medicare billing is not my forte'.  Most of my clients are fee for service or straight CareFirst/Anthem, so I feel inept billing Medicare.  Typically, I bill Medicare with my letter and such, then client sends me the denial.  I take denial and create paper claim to CareFirst attaching Medicare denial.  Provider eventually gets paid. 

However, after reading the Medicare website I thought I was doing this all wrong and thought I was supposed to be using the GY modifier.  Should not have second guessed myself because my system gets the provider paid and that is all that matters. 

I apologize for the confusion and I am not going on that website again!!! :-[

Thanks again....will leave well enough alone...

Regards,

Debbie

Merry:
Please.. Nothing to apologize about.  I just wanted to be sure that we understood you.  Please do hang out here.  There are lots of people here that bill mental health so stay in touch please.

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