Medical Billing Forum

Coding => Coding => : Lisa@srts-inc.com February 02, 2011, 02:31:04 PM

: How can I bill a 90806 & 90853 same day to Medicare
: Lisa@srts-inc.com February 02, 2011, 02:31:04 PM

Hello,

I am trying to bill an individual therapy (90806) and a group therapy (90853) on the same day for the same patient to Medicare ( Massachusetts) but they are denying.  I tried to bill one visit with modifier 25 and still denied.

Any suggestions??

Thanks
Lisa

: Re: How can I bill a 90806 & 90853 same day to Medicare
: rdmoore2003 February 02, 2011, 04:54:00 PM

Is the rendering provider the same for both services?

: Re: How can I bill a 90806 & 90853 same day to Medicare
: camedbill February 02, 2011, 05:33:28 PM

I don't believe you can bill two therapy codes on one day especially to Medicare regardless if same provider or not

: Re: How can I bill a 90806 & 90853 same day to Medicare
: rdmoore2003 February 02, 2011, 05:58:25 PM

The only way that it could be done is if it is separate rendering providers under separate group numbers. 
But yes generally you cannot have two therapies in the same day.   you cant do 96101 and 96102 in the same day either.

: Re: How can I bill a 90806 & 90853 same day to Medicare
: Lisa@srts-inc.com February 02, 2011, 06:00:28 PM

Yes, it is the same rendering.  The provider told me that the hospital she works for is able to do this but I never considered that they are probably billing the same patient but 2 different providers.

Thanks so much for the help.
Lisa

: Re: How can I bill a 90806 & 90853 same day to Medicare
: Michele February 03, 2011, 11:51:29 AM

Also, if the hospital is billing for facility portion that would make a difference too.