Mental Health Modifiers: The Definitive Guide 2023

The contractor information can be found at the top of the document in the Contractor Information section (expand the section to see the details). The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Another revision is the deletion of Category III codes 0702T and 0703T, which had previously been used to report RTM of CBT. There must be at least one interactive communication with the patient or caregiver for and 98981. They represent the review and monitoring of data related to, but not limited to, a therapeutic response and allow physicians to assess the impact of a particular treatment regimen.

There are many different mental health treatments and services with varying restraints that can make medical billing difficult. To break it down, let’s compare it to routine checkups at a doctor for your physical health. The doctor will usually perform the same exams and tests for many patients, such as checking blood pressure, height, weight, listening to your heart or getting blood samples. Our billing service exclusively for mental health providers is here to help.

Minimum Required Patient Information

When this happens, you may use CPT® code 90785, the designated add-on code to report interactive complexity, in conjunction with the appropriate psychotherapy service, to report to insurers about the services you’ve provided. You can pair the add-on code with diagnostic evaluation (90791, 90792) or psychotherapy treatment session (90832, 90833, 90834, 90836, 90837, 90838, 90853). If you are struggling to do each of these tasks for your insurance clients, considering hiring a mental health billing service like TheraThink to solve these problems for you. We’ll teach you what behavioral health modifier to use for your insurance claims based on your license or degree, including the CPT codes allowed for those services. This is yet one more reason why mental health providers choose billing services like TheraThink to help. Payments for the CoCM codes go entirely to the primary care physician who bills for the service, Dr. Ratzliff told webinar viewers.

• Errors, accidental or otherwise, will directly impact insurance company’s payment of services.
• Upcoding, or overcoding, is also illegal and commonly done to receive higher reimbursement.
• To do this, you can call the patient’s insurance company provider using their account number to get a better idea of their benefits.
• You have all the necessary patient and session information to file claims.
• We help the mental health providers that work with us in our billing service do all of this for every appointment.
• Having the customer service phone number isn’t essential for submitting claims, but is necessary to gather eligibility and benefits information and to verify claim status and payment amounts.
• If you are struggling to do each of these tasks for your insurance clients, considering hiring a mental health billing service like TheraThink to solve these problems for you.

Learning more about the mental health billing process can make it easier for you to spend more time and energy on your patients and less on inconvenient discrepancies. If you are struggling to find out the right modifier to use, mental health billing consider hiring our mental health insurance billing service to code your insurance claims for you. Diagnosis coding allows mental health professionals to identify different treatments, diagnoses or actions given to the patient.

For Clinicians: CPT Codes for Psychotherapy and Other Psychology Services

It is important to recognize situations that require the reporting of interactive complexity in conjunction with diagnostic evaluation or one of the appropriate individual psychotherapy vs. psychotherapy for crisis (90839 and 90840). Psychotherapy for an older elementary school-aged child accompanied by divorced parents, reporting declining grades, temper https://www.bookstime.com/ outbursts, and bedtime difficulties. Parents are extremely anxious and repeatedly ask questions about the treatment process. Each parent continually challenges the other’s observations of the patient. Use the add-on CPT® code for interactive complexity to bill for sessions where communications factors impact your ability to complete a service.

Upcoding is when a provider uses a code that reflects a more severe diagnosis or higher-priced treatment than is accurate for a patient. However, undercoding and upcoding can easily result from an untrained employee who doesn’t have adequate coding knowledge. When submitting a claim, you must ensure that you do so in the correct billing format based on the insurance company you are filing with. To make this process easier, identity the insurance company’s preferred filing method and the window of time they allow for filing claims. You will certainly want to file your claim within that window of time, or you run the risk of a prolonged claims process.