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    Wiki OTP G-codes help please

    G2080 is an add on code and must be billed with the primary code which would be G2074. So they go on the same claim with the same DOS. We bill all services Sunday to Saturday. I attached the Medicare OTP Manual..hopefully that will help you. If you need additional help let me know as I am very...
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    Wiki What CPT to use for Substance Abuse Residential Program

    We use H2036
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    Wiki H0004 and H0005 -what codes can I use for Medicare?

    Do 90832-90839 apply to what you are providing? Those can go to Medicare but only by certain providers.
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    Wiki Treatment Plan billing

    We do not bill for treatment plan updates
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    Wiki Treatment Plan billing

    Who is doing your SUD treatment plan updates? A physician or NP or one of the counselors?
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    Wiki New G codes to bundle opioid use disorder treatment

    I would think Case Management would be included as it is included in our OTP G codes. Office-Based Treatment Substance Use Disorder (SUD) bundled services G2086Office-based treatment for substance use disorder, including treatment plan development, care coordination, therapy and counseling; at...
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    Wiki supervision rules for LPCC, LISW, LPC, LSW, LFMT

    Licensed Independent Behavioral Health Practitioners (I-BHPs)The following are professionals who are licensed by a professional board in the state of Ohio and areauthorized to practice independently (they are not subject to professional supervision) and have specialtyexperience and/or training...
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    Wiki Prior Auth and H0015

    If we do not have auth (either because was denied, staff didn't get, etc) we will bill H0015-HK-provider modifier instead of H0015-HK-provider modifier-TG to OH Medicaid. I have never had any issue with changing it.
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    Wiki OTP/MAT Billing

    If you bill the OTP G codes for your Medicare clients they are a bundled code and everything they have during that 7 day period is included. (ie, UDS, counseling, case management, etc) If they have a physician visit during that week you can bill a G2077 (periodic assessment, assessing...
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    Wiki Code 90791

    We use 90791 for the initial visit/diagnostic assessment only. Some of the insurances for instance Ohio Medicaid it can only be billed once per calendar year without prior auth. So check with the payer as well as to their guidelines. We just use it for the initial then they use other cpt codes...
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    Wiki 90791/90792 vs E&M

    There are two codes for psychiatric diagnostic evaluation. 90791 Psychiatric diagnostic evaluation 90792 Psychiatric diagnostic evaluation with medical services 90791 is used by psychologists, social workers and other licensed behavioral health professional and 90792 is used by psychiatrists...
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    Wiki Medicare SUD coding debate

    To bill Medicare for the G codes you must be a Medicare enrolled OTP provider then you MUST use the bundled codes per MLN8296732. We have a lot of clients/patients that we bill for this service. If they dose daily or have a 1 week take home we bill G2067 or G2068 (meth/buph) It is billed each...
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    Wiki T1003 - documentation

    Table 4-7: SUD RN and LPN Nursing Services SUD Service Provider Type Code Modifier Rate Nursing Services – Individual RN T1002 - $31.92 – provided in the office $41.00 – provided in the community LPN T1003 - $22.54 $29.13 Nursing Services – Group RN T1002 HQ $10.37 Unit Value 15 minutes...
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    Wiki LPC + Medicare Questions

    LPCs are not able to be reimbursed by Medicare, they are statutorily excluded. Is this clients secondary a medicare supplement or a commercial insurance? Medicare does not accept claims for "denial purposes only". If the secondary is a Medicare supplement they only pay if Medicare does. If the...
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    Wiki Methadone Take Homes

    In the Ohio manual we bill the H0020 with one of several modifiers: OTP Daily Administration HF OTP One Week Administration (2 – 7 Days) TV OTP Two Week Administration (8 – 14 Days) UB OTP Three Week Administration (15 – 21 Days) TS OTP Four Week Administration (22 – 28 Days) HG
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    Wiki Methadone Take Homes

    I live in Ohio and we bill the H0020 with a modifier TV (7 days) or a UB for (8-14) days. We bill the date of service as the Sunday starting that week. You will need to look at your Medicaid BH manual for your state to see what your state requires. I attached what I found for NJ you may have...
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    Wiki 90853 and 90839 same day

    According to my information and NCCI edits they cannot be billed on the same day.
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    Wiki CDAC 90837

    Yes, in Ohio we use a U6 to show a CDCA performed services. Paid at direct supervisor rate when supervisor NPI on claim Paid at 72.25% of maximum fee if supervisor NPI not on claim. Check your state medicaid website for BH manual.
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    Wiki H0038SUD PEER SUPPORT CODE

    We are getting it paid. Are you adding the correct modifier with it? Is it any particular payer or all of them?
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    Wiki 90846 and 90847 on the same day

    NCCI edits show a modifier category of 1 which means the edit may be bypassed with the appropriate modifier added. Depending on the payer...i have had some that will pay when the edit is 1 and some that won't pay.
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    Wiki SUD OH Medicaid Billing

    https://bh.medicaid.ohio.gov/manuals https://bh.medicaid.ohio.gov/Portals/0/Providers/Manual/2-11-2021%20BH%20Manual%20FV%201_17.pdf?ver=R93mZDtSdK7QfQYt_ZMjGA%3d%3d This page has been basically my bible to billing Ohio Medicaid.
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    Wiki Per Diem and units

    This is how our medicaid explains it... • Only used if the person attends for the minimum needed to bill the per diem (2+ hours) in a group which does not exceed the practitioner‐to‐client ratio • If person doesn’t meet the minimum 2+ hours, 90853 or H0005 may be used • Service is billed in...
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    Wiki Eye Help!

    Eye Help I would code the 67311-LT 67345 J0585 The CPT code 67340 states strabismus surgery involving exploration and/or repair of detached extraocular muscle(s). After reading the op report, I do not see that the muscle was detached. They moved the muscle and reattached it to the sclera. We...
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    Wiki Anterior Vitrectomy

    A vitrectomy is where the vitreous humor inside the eye cavity is removed. There is a posterior or pars plana vitrectomy (used for treating issues in the posterior part of the eye such as near the retina-gives the doctor access to the back of the eye) and an anterior vitrectomy (where vitreous...
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    Wiki Anterior Vitrectomy

    anterior vitrectomy There are two CPT codes for anterior vitrectomy: 67005: Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal 67010: Subtotal removal with mechanical vitrectomy A parenthetical note states: “For removal of vitreous by...
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    Wiki NCD 80.11 vitrectomy coding confusion

    Vitrectomy Previous to my other reply, we just had two 67041 denied for the same reason. After checking with CMS and other ophthalmology offices..it is a CMS issue. CMS sent out NCD last year stating certain dx codes were not applicable for Vitrectomy...macular pucker is one and there is a...
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    Wiki Best Specialty Coding Book for Opthalmology

    coding book We use the Optum 360 Ophthalmology comprehensive illustrated guide to coding and reimbursement as well.
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    Wiki NCD 80.11 vitrectomy coding confusion

    Vitrectomy Is it one specific payer? I work for an ASC that does ophthalmology procedures only. I have not had any issues getting either of those codes paid. I have billed 67041 with H35.371 and it was paid. Are you billing facility? physician?
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    Wiki help with coding this procedure

    67108 Repair of retinal detachment; with vitrectomy, any method including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique Is this the code you are looking for? 67018...
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    Wiki Medicare guidlines for skilled nursing home visits

    Medicare requires visits every 30 days for the first 90 days after admission, then once every 60 days. More frequent visits, without documented medical necessity, may invite an audit. Some states don't allow NPs to perform all the required visits, but they can perform some of them, taking turns...
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    Wiki Medicare guidlines for skilled nursing home visits

    Medicare guidelines for skilled nursing home visits Yes the physician must do the initial H&P on a skilled nursing home patient. The NP can make a "medically necessary" visit without the physician initially seeing the patient if they have an issue that requires attention before the physician...
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