Author Topic: Psych testing by LPC  (Read 52 times)

EBurleyStill

  • Newbie
  • *
  • Posts: 10
Psych testing by LPC
« on: July 19, 2021, 01:07:20 AM »
I am billing for an LPC who does psych testing.  She's billing 96130 and 96131.  All of her BCBS claims have denied.  This was before we started billing for her.  Not positive on prior auth being obtained, but she bills within the normal unit limits.
After much communication with the provider reps, she was told that she was not contracted with Anthem for billing testing. 
Has anyone heard of this?  Does one have to specifically ask to bill certain codes? I have more experience with MDs & PHDs.  I know there are certain limits as to what can be billed by LPCs and must use proper modifiers but this puzzles me.
Thanks for any assistance!

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 5811
    • Solutions Medical Billing
Re: Psych testing by LPC
« Reply #1 on: July 20, 2021, 11:26:50 AM »
Is the LPC being reimbursed by other insurances for the psych testing?  We bill a lot of mental health, including psych testing.  I am not surprised that it is not covered when performed by an LPC. 
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

EBurleyStill

  • Newbie
  • *
  • Posts: 10
Re: Psych testing by LPC
« Reply #2 on: July 20, 2021, 03:04:04 PM »
Thank you for your reply.  Yes she is getting reimbursed by Tricare East & several of the Medicaid CMO's. 

That's why it is so strange that Blue Cross is saying that she is not contracted for that.  The provider rep has scheduled meetings with her to discuss the issue & keeps rescheduling.  She is considering taking the issue to the insurance commissioner...  :-\

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 5811
    • Solutions Medical Billing
Re: Psych testing by LPC
« Reply #3 on: July 20, 2021, 09:48:08 PM »
Wow, I'm surprised.  But if the rep isn't responding and can't show something in writing as to why it's not covered, then the insurance commissioner may be your best bet.

Does the LPC have a copy of the BCBS contract?  Maybe it addresses it in there.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Medical Billing Forum

Re: Psych testing by LPC
« Reply #3 on: July 20, 2021, 09:48:08 PM »