Question about psych testing codes and Optum/United

[randomdoc1]

The codes most commonly used in my office are (notes are more for my own reference)
96130 Psychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
96131 each additional 1 hour
96138 Psychological or neuropsychological test administration/scoring by technician, two or more tests, any method; first 30 minutes
96139 each additional 30 minutes

Most insurances don't give too much of a fuss, but United does-even with an authorization for testing codes. Have any of you encountered issues with limits such as:
-how many of each CPT is allowed per day?
-how many testing CPT codes allowed total per day?
-96138 and 96139 need to be done on days separate from 96131 and 96130?
-once you bill any of these codes do you have to wait a certain time before you can bill them again if all the testing services were not done in one day? Or is it better to just bill and do everything in one day?
I get the feeling there is some sort of grace period or time limitation but of course, United would not say what it is. While other insurances are transparent about this so we can schedule and render accordingly.

Sometimes we get denied claims and all the rep says they are allowed to say is that it did not meet billing requirements as specified in the provider manual and they indicate it has more to do with the number of units a day or which units were asked the same day. But they of course don't direct us to where we can find the manual or what exactly the recommended billing procedures are. So I'm just looking around to see if anyone here has any billing insights or experiences with these codes. Thanks! @WisNeuro ?

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[PsyDr]

explain why you should have access to psychologists CPT codes, when your org blocked our access to your CPT codes, at a federal level.

 

[randomdoc1]

explain why you should have access to psychologists CPT codes, when your org blocked our access to your CPT codes, at a federal level.

I do the billing for the psychologists here and we train PsyD and PhD students. I don't do testing. Just trying to get providers at this office paid and fund the education of the students. Not exactly sure what is supposed to be meant by "my" org. I, personally, don't participate in any orgs or provide funding.

 

[erg923]

The codes most commonly used in my office are (notes are more for my own reference)
96130 Psychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
96131 each additional 1 hour
96138 Psychological or neuropsychological test administration/scoring by technician, two or more tests, any method; first 30 minutes
96139 each additional 30 minutes

Most insurances don't give too much of a fuss, but United does-even with an authorization for testing codes. Have any of you encountered issues with limits such as:
-how many of each CPT is allowed per day?
-how many testing CPT codes allowed total per day?
-96138 and 96139 need to be done on days separate from 96131 and 96130?
-once you bill any of these codes do you have to wait a certain time before you can bill them again if all the testing services were not done in one day? Or is it better to just bill and do everything in one day?
I get the feeling there is some sort of grace period or time limitation but of course, United would not say what it is. While other insurances are transparent about this so we can schedule and render accordingly.

Sometimes we get denied claims and all the rep says they are allowed to say is that it did not meet billing requirements as specified in the provider manual and they indicate it has more to do with the number of units a day or which units were asked the same day. But they of course don't direct us to where we can find the manual or what exactly the recommended billing procedures are. So I'm just looking around to see if anyone here has any billing insights or experiences with these codes. Thanks! @WisNeuro ?

You submit a bill when the evaluation is done. Not a little at a time.

 

[PikminOC]

explain why you should have access to psychologists CPT codes, when your org blocked our access to your CPT codes, at a federal level.

Are you referring to Psychiatrists using these billing codes? Many do and some also do testing, and it's been fine.

 

[AcronymAllergy]

Mod Note: Before we get too far afield, let's try to stay on-topic and, as always, helpful and professional. Thanks.

 

[PsyDr]

Are you referring to Psychiatrists using these billing codes? Many do and some also do testing, and it's been fine.

In 2020, the American Psychiatric Association lobbied the US Congress to prevent psychologists from being able to bill Medicare without a referral. They stated that they did not want psychologists to have E/M codes, and noted that psychologists should stick to using psychologist CPT codes. The SDN psychiatry forum was active in lobbying against psychologists being able to bill without a referral, and to use E&M codes. I believe SDN psychiatry called it a "bad bill".

If that is the way it is to be, it seems unfair for psychiatry to use our codes.

 

[AcronymAllergy]

The codes most commonly used in my office are (notes are more for my own reference)
96130 Psychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
96131 each additional 1 hour
96138 Psychological or neuropsychological test administration/scoring by technician, two or more tests, any method; first 30 minutes
96139 each additional 30 minutes

Most insurances don't give too much of a fuss, but United does-even with an authorization for testing codes. Have any of you encountered issues with limits such as:
-how many of each CPT is allowed per day?
-how many testing CPT codes allowed total per day?
-96138 and 96139 need to be done on days separate from 96131 and 96130?
-once you bill any of these codes do you have to wait a certain time before you can bill them again if all the testing services were not done in one day? Or is it better to just bill and do everything in one day?
I get the feeling there is some sort of grace period or time limitation but of course, United would not say what it is. While other insurances are transparent about this so we can schedule and render accordingly.

Sometimes we get denied claims and all the rep says they are allowed to say is that it did not meet billing requirements as specified in the provider manual and they indicate it has more to do with the number of units a day or which units were asked the same day. But they of course don't direct us to where we can find the manual or what exactly the recommended billing procedures are. So I'm just looking around to see if anyone here has any billing insights or experiences with these codes. Thanks! @WisNeuro ?

I've not heard of issues billing 96130/96131 the same day as the testing codes (96138/96139). I have heard issues about billing 96138/96139 on the same day as 96136/96137. I've also consistently seen guidance to enter all billing at the same time once everything is done, as was said above. If there are quantity limits, those are probably carrier-specific, and even probably carrier-location-specific. I don't know anything about United off-hand.

Also yes, psychologists' access to E/M codes and not needing a referral for Medicare (e.g., adding psychologists to the Medicare definition of physician) would be ideal.

 

[PikminOC]

In 2020, the American Psychiatric Association lobbied the US Congress to prevent psychologists from being able to bill Medicare without a referral. They stated that they did not want psychologists to have E/M codes, and noted that psychologists should stick to using psychologist CPT codes. The SDN psychiatry forum was active in lobbying against psychologists being able to bill without a referral, and to use E&M codes. I believe SDN psychiatry called it a "bad bill".

If that is the way it is to be, it seems unfair for psychiatry to use our codes.

I'm not a member of them. I'm not paying those fees. In terms of fairness, your apa can always lobby as well.

 

[AcronymAllergy]

Ok, replies have been made; let's return to the original topic of the thread. If folks want to break off a separate thread relating to lobbying efforts against/for psychology or other practice issues, feel free to do so.

 

[PikminOC]

With testing I have seen umr they don't like the same codes the same day. So I guess do the minimum testing at a time to get reimbursed?

 

[erg923]

With testing I have seen umr they don't like the same codes the same day. So I guess do the minimum testing at a time to get reimbursed?

Again, testing evaluations are billed when the evaluation completed. Not days/bits at a time. Maybe a 59 Modifier is needed here, I don't really know?

This really is a coding and claims type question for United (UBH) more than any thing else. I'm not sure how we can help you more here?

 

[WisNeuro]

Yeah, I drop all of my testing codes when the eval is done, usually after feedback. Hasn't been an issue so far.

 

[PikminOC]

Again, testing evaluations are billed when the evaluation completed. Not days/bits at a time. Maybe a 59 Modifier is needed here, I don't really know?

This really is a coding and claims type question for United (UBH) more than any thing else. I'm not sure how we can help you more here?

Umr just doesn't want to cover it. The receipt is given after the testing is complete. They raise a stink of more than one thing is done a day. Their system can't compute. I really don't care. This is to help the op understand I've seen this too.

 

[smalltownpsych]

If one code is for a tech administering it and the other is for a psychologist and those are the same day that might be what they are objecting to. I’ve run into the ame problem with seeing the psychiatrist and psychologist on the same day. More convenient for patients, but the third party can make their own rules. I love that they won’t tell what the rules are.

 

[WisNeuro]

If one code is for a tech administering it and the other is for a psychologist and those are the same day that might be what they are objecting to. I’ve run into the ame problem with seeing the psychiatrist and psychologist on the same day. More convenient for patients, but the third party can make their own rules. I love that they won’t tell what the rules are.

That's my guess, some insurers don't seem to know how to handle billing for psychologist and tech codes on teh same visit.

 

[AcronymAllergy]

That's my guess, some insurers don't seem to know how to handle billing for psychologist and tech codes on teh same visit.

Agreed, I've recurrently seen this mentioned as a problem (i.e., billing 96136/19637 and 96138/96139 on the same day).