is work performed by a psych assistant billable?

[sydb1367]

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to medicare, blue cross, etc.

 

[falseimitation]

to medicare, blue cross, etc.

From what I understand, you have to have at least a Master's degree to be billable to insurance and Medicaid. Correct me if I'm wrong, but I think you need something more to be Medicare billable.

 

[stigmata]

In Ca. Yes it is all billable.

 

[docma]

Psych assistants cannot bill Medicare to my knowledge, definitely not in California. I question the assertion below about "all billable in California". Clients of psych assistants must make payments to the supervisor. I am surprised that any private insurance panels would pay for services that were not delivered directly by the supervisor or for those delivered by unlicensed providers, even under supervision. Each state and each insurance provider can have different policies on this so the question needs to be much more specific and probably only answered by regulatory boards or providers for accuracy. Public systems (eg: Medicaid) can reimburse public systems (eg: municipal clinic or public hospital) because services are "capitated" by the system, which is licensed and employees within the system can be certified by the system to provide services (eg: interns, peer providers) under specific licensed supervisors.

 

[stigmata]

Psych Assts are mainly used for testing and yes it is billable as 96102

 

[docma]

Here is one of the sources of confusion on this issue: PA, in my understanding, is a licensed Physicians' Assistant and it remain unclear to me how Medicare views a "psychological assistant" which is a registered but not licensed position (which is different from student/trainee). I suppose each organization sorts this out differently and hopes their auditors agree.

"Accordingly, Medicare does not pay for services represented by
CPT codes 96102 and 96119 when performed by a student or a trainee. However, the presence of a student or a trainee while the test is being administered does not prevent a physician, CP, IPP, NP, CNS or PA from performing and being paid for the psychological test under 96102 or the neuropsychological test under 96119."
www.wpsmedicare.com/part_b/.../l30489_psych014_cbg.pdf

 

[sydb1367]

So I contacted the director of professional affairs for my state's psych association and he said that cpt 96119 can be used to bill for psych assistant npsych testing.

However, the quote above: "Medicare does not pay for services represented by CPT codes 96102 and 96119 when performed by a student or a trainee"
seems to contradict this. But then I have friends who work as psych assistants for post-doc who bill under this code. So I am utterly confused.

 

[AcronymAllergy]

So I contacted the director of professional affairs for my state's psych association and he said that cpt 96119 can be used to bill for psych assistant npsych testing.

However, the quote above: "Medicare does not pay for services represented by CPT codes 96102 and 96119 when performed by a student or a trainee"
seems to contradict this. But then I have friends who work as psych assistants for post-doc who bill under this code. So I am utterly confused.

Might depend on whether the "psych assistant" is a student/trainee or an actual psychometrist-level assistant?

 

[stigmata]

Psych Asst in Ca. is not trainee or student. They can be in that trajectory, but they are essentially an employee of a licensed psychologist.

 

[sydb1367]

sorry, I have been horribly vague in what I am asking.

I have met a neurpsychologist who may be willing to take me on as a psych assisstant. At first I would still be a student, while I finish my dissertation, and wouldn't be needing the hours for licensure or anything as I will have already completed my pre-doc internship. After that, I would be doing it as a post-doc and collecting hours for licensure. The question is, will he be able to bill for my work doing neuropsych evals with medicare patients (under CPT code 96119 for npsych testing by a tech)?

I know it happens, but per Docma's quote, it appears that it shouldn't.

It seems like it would be damn near impossible to have a paid post-doc if one can't bill for their work with medicare patients.

 

[sydb1367]

Psych Asst in Ca. is not trainee or student. They can be in that trajectory, but they are essentially an employee of a licensed psychologist.

sweet 😀

Stigmata, do you know where I can find documentation of this to show my prospective employer?

 

[docma]

It makes sense that you can work as an employee, essentially a psychometrist, under his supervision. Since he will be billing under his license, however, it is probably important that he confirm this directly as well. And I'm sure he'll appreciate you showing him exactly how that can be done. Medicare is a thicket but if you persist you get through it.

 

[stigmata]

If I remember correctly the Ca. Board of Psychology's information packet on psych assistant registration has all the information needed. It is made very clear that the psych asst is an employee. Just go to their website.

 

[aequitasveritas]

I am a psych assistant in CA. Yes, we bill for all insurances (except HMOs or Medical...Medicare is fine) and I haven't had a problem getting paid.

The one difficult thing to get paid for is testing through Medicare or HMOs. So you may be up against it.

There was an assertion above that psych assistants are mainly used for testing; I challenge this. Most in my area are used to provide psychotherapy with occasional testing. I have a client load of anywhere from 17-20 and I complete full assessments when they come in...not just "testing".

Each billing statement sent to the insurances has my information at the bottom and indicates that I am the immediate provider.

 

[stigmata]

I just meant that using them for testing is a much better financial arrangement for the psychologist. Of course they can do therapy if that is what the psych does and wants of them.

 

[sydb1367]

The one difficult thing to get paid for is testing through Medicare or HMOs. So you may be up against it.

Why aren't you able to use CPT 96119 or 96102 to bill medicare for testing?

 

[aequitasveritas]

Why aren't you able to use CPT 96119 or 96102 to bill medicare for testing?

Medicare has just been very, very slow to reimburse testing. They pay regularly and quickly for therapy but they often reject the billing hours for testing and you have to resubmit less hours etc. It has been a hassle.
One problem is that you may need 12+ hours for a neuro or comprehensive assessment (admn, scoring, intepreting, writing) yet they often have a maximum of 8 hrs billable. So you're going to be working alot more than you get paid. This is true of most therapists and we end up getting paid for around 85-98% of what we work for. For assessment through insurances it is worse.

 

[erg923]

Medicare has just been very, very slow to reimburse testing. They pay regularly and quickly for therapy but they often reject the billing hours for testing and you have to resubmit less hours etc. It has been a hassle.
One problem is that you may need 12+ hours for a neuro or comprehensive assessment (admn, scoring, intepreting, writing) yet they often have a maximum of 8 hrs billable. So you're going to be working alot more than you get paid. This is true of most therapists and we end up getting paid for around 85-98% of what we work for. For assessment through insurances it is worse.

I am not a big fan of letting the insurance industry dictate our practice standards (yet I realized this has already happened to some degree), but why would some one do 12 hours worth of work if they only get reimbuirsed for 8?

I think I would probably be shortening that report to little more than a summary (rather than slashing alot of testing) if that was the case. I can't say I would tolerate/accept working for free...

 

[aequitasveritas]

I am not a big fan of letting the insurance industry dictate our practice standards (yet I realized this has already happened to some degree), but why would some one do 12 hours worth of work if they only get reimbuirsed for 8?

I think I would probably be shortening that report to little more than a summary (rather than slashing alot of testing) if that was the case. I can't say I would tolerate/accept working for free...

Yeah, I have absolutely reigned in the amount of work I do on a lot of reports.
It's highly problematic when I have a necessary battery of 12 + hrs persuant to the questions asked from the source, yet I know, based on prior experience, that they have a filtering department stating how long they think it should take me and what they'll pay...no matter how long it actually takes.
It's a real problem.

 

[aequitasveritas]

Insurance panels have absolutely deflated our earnings. There is no way we should be paid as little at 70-80/hr (and that's good rate for most insurances out there).

I think health insurance companies should be mandated as non-profit. Let em have big salaries and great lifestyles, but the mega bonuses (i.e. United Health -400mill) should be going to the providers (like us!!)

I can't tell you how much minutia is entailed in the insurance processing, even if you contract it out. Most patients will need treatment authorization at some point, it usually takes 15-20 minutes on the phone with the companies just trying to get the copay amount and allotted sessions per diagnosis. Multiply all that by 35 patients a week and it gets crazy.

 

[tennislove]

Does this mean you are on an insurance company's panel? or does this mean you bill for services as an out of network provider? In CA it is my understanding you can bill for Medicare as a provide as a PA. If so, how long did the process take?
Thank you.

 

[sydb1367]

Does this mean you are on an insurance company's panel? or does this mean you bill for services as an out of network provider? In CA it is my understanding you can bill for Medicare as a provide as a PA. If so, how long did the process take?
Thank you.

As a psych asst, you can't bill insurance, but your supervisor can.

As far as medicare goes, after months of investigating, I have found no consensus. The vast majority of people I asked (including my employer) bill medicare for work done by PAs, including as post-docs. A few argued that it is disallowed by medicare's stipulation that work performed by students or trainees is not billable. of course PAs needn't be students/trainees.

 

[nicksternick]

I am a psych assistant in CA. Yes, we bill for all insurances (except HMOs or Medical...Medicare is fine) and I haven't had a problem getting paid.

The one difficult thing to get paid for is testing through Medicare or HMOs. So you may be up against it.

There was an assertion above that psych assistants are mainly used for testing; I challenge this. Most in my area are used to provide psychotherapy with occasional testing. I have a client load of anywhere from 17-20 and I complete full assessments when they come in...not just "testing".

Each billing statement sent to the insurances has my information at the bottom and indicates that I am the immediate provider.

When you write "except HMOs and Medi-Cal", just to clarify, does that mean supervisors can bill only PPOs and Medicare for services provided by their psych assistants?

 

[aequitasveritas]

When you write "except HMOs and Medi-Cal", just to clarify, does that mean supervisors can bill only PPOs and Medicare for services provided by their psych assistants?

Psych assistants cannot bill patients who are medical only.

As far as I know HMO's have regulations that exclude psych assistants.

 

[Avocadobunny]

Hi everyone, I know this thread is a bit old but it was extremely helpful. What I found out was for a Psych Assistant the code 96102 should be used for general psych testing and 96119 for neuropsych testing. These codes can only be used if your supervisor also uses their codes because a PA cannot bill for solo testing, they must be supervised.

However, I was curious about billing for any type of therapy?
Is that beyond the scope of what a psych assistant can do?
If not, would it be possible to somehow bill instead of just having private pay sliding scale clients?
What code(s) could be used?

If anyone has some insight into this it would be extremely helpful!

p.s. I am in California, I know things vary a bit between states

Thanks

 

[PHD12]

Hi everyone, I know this thread is a bit old but it was extremely helpful. What I found out was for a Psych Assistant the code 96102 should be used for general psych testing and 96119 for neuropsych testing. These codes can only be used if your supervisor also uses their codes because a PA cannot bill for solo testing, they must be supervised.

However, I was curious about billing for any type of therapy?
Is that beyond the scope of what a psych assistant can do?
If not, would it be possible to somehow bill instead of just having private pay sliding scale clients?
What code(s) could be used?

If anyone has some insight into this it would be extremely helpful!

p.s. I am in California, I know things vary a bit between states

Thanks

Hi avocadobunny:

All the psych assistants i've met in CA are taking private pay sliding scale only for therapy. From what i've heard, they cannot take insurance. They charge a fee that is lower than a licensed psychologist and then split the fee (arrangement varies between 70% to 40%, generally favoring the supervisor) with the supervising psychologist. If you are using these hours for licensure, just make sure you sign the supervision agreement before you start and that the psychologist supervising you has a rich source of referrals and a busy practice. Otherwise, you will not be able to get your hours in a timely manner and will not be able to support yourself financially. I've met some folks who were stuck doing this for years because they didn't pick someone who helped them get patients.