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Medicare 90853 and 90837 on same day

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ERBurley:
I am having an issue with billing medicare for a patient receiving individual therapy (licensed psychologist) then sitting in with the group on the same day.  We billed 90837 on line 1 then 90853 with modifier 59.

This resulted in the group fee being paid (why line 2 before line 1?) and the individual therapy being denied for M80, not covered when performed during the same session/date as a previously processed service for the patient, and CO-B-15 This service requires that a qualifying service be received and covered.  This qualifying service has not been received.

I want to appeal this but I'm not sure how to proceed.  Any pointers or advice? 

Thanks so much!

Elizabeth Burley

LoveBilling:
The Group Codes takes precedence which means modifiers go on the individual codes, in this case 90837 not 90853, as long as your documents supports the use of the modifier you should get paid for both by adding the modifier to the right code.

Check the NCCI edits for these codes, I haven't used in a while but I'm most certain this is the issue.

Hope this helps.

PMRNC:
Most carrier's will not pay these on the same date. My mental health clients with patients in both individual and group do these on separate days. I don't know of any carrier who will pay both on same day.

Julieb19:
I know this is an old post - but I do want to add to this, I bill a 90837 and 90853 and use the Modifier XE and this is paid.  I hope this helps anyone!

Jennifer:
Thanks for the update, what about billing a 90837 with an add on for 30 minutes 90832? What modifier do you use and have you been paid for these on the same day?
Thank you!

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