Medical Billing Forum

Coding => Coding => : surfergirl February 05, 2019, 03:24:44 PM

: CPT 90785 for 2019 UPDATE
: surfergirl February 05, 2019, 03:24:44 PM

Hello Fellow Billers.
I have noticed that for mental health 90785 with 90834 is getting reimbursed for federal blue cross for 2019. It has always paid with cigna and UBH.
Reg Blue Cross still is not paying anything on this code.
Am I missing something? I have not used a modifier but should I for reg Blue Cross to get both CPT codes to pay. If so which one, -25?
So in summary payment for 90834 but no payment for 90785 for reg BCBS of NC.

Thank you.

Surfer Girl

: Re: CPT 90785 for 2019 UPDATE
: Michele February 08, 2019, 10:24:17 AM

A modifier is not required when using that code.  What is the reason code on the eob?

: Re: CPT 90785 for 2019 UPDATE
: PMRNC February 19, 2019, 05:07:15 PM

I agree with Michele, they should not need modifier the 90834 is add on to one of the complexity codes. Are they flat out denying that line item OR are they bundling?

: Re: CPT 90785 for 2019 UPDATE
: surfergirl March 12, 2019, 08:26:59 PM

Hello PMRNC and Michele,

The EOB states the following:
the CPT code 90785 is an add-on code.
The following adjustments to the total fee were made by the insurance company:
1. Amount: $20.00, Description: Contractual Obligation--The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

Therefore bundled together. It just makes me question the inconsistency with Federal paying and Reg Blue Cross is not starting 2019. Cant get an answer from Blue Cross.

Thank you for your response.

Surfer Girl

: Re: CPT 90785 for 2019 UPDATE
: Michele March 14, 2019, 12:03:19 PM

That reason doesn't really state why the claims are not being considered separately.  Have you called to ask for an explanation?