Wiki 96130 & 96131

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PaulaLB

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I have a question in mental health billing 96130 & 96131. I know that 96131 is the add on code and I was told by an insurance rep that they must be billed for the same date of service. The office I bill for have one date of service for 96130 and another date of service for 96131, so what is the correct procedure for billing these CPT codes. The techs notes show the two separate dates for the service, therefore if I bill the two CPT for the same date of service is incorrect and fraudulent. I would appreciate any help with this issue. Thank you ahead of time.
 
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PaulaLB said:
I have a question in mental health billing 96130 & 96131. I know that 96131 is the add on code and I was told by an insurance rep that they must be billed for the same date of service. The office I bill for have one date of service for 96130 and another date of service for 96131, so what is the correct procedure for billing these CPT codes. The techs notes show the two separate dates for the service, therefore if I bill the two CPT for the same date of service is incorrect and fraudulent. I would appreciate any help with this issue. Thank you ahead of time.
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APA's answer.
 
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F41.1, Generalized anxiety disorder; F81.0, Specific reading disorder.

96130, psychological testing services by physician, first hour
96131, psychological testing services by physician, each additional hour
96136, psychological testing services by a psychologist, first 30 minutes
96137, psychological testing services by a psychologist, each additional 30 minutes

I am assuming you are not trying to bill all four CPT codes by one provider, and if so, that is the problem. You're either a physician or you're a psychologist (for the purposes of these codes), you're not both.

If you are saying you billed those codes separately, but they denied for diagnosis, have you checked to see what the plan covers as far as psych testing goes? Is this an adult, and if so, does the plan cover reading disorders for adults? Is F41.1 on the list of covered diagnoses?
 
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Hello - Can some tell me how to assign one date of service. Lets say the patient testing in a period of three days. Starts on 5/1 and ends on 5/3. Then the provider does the Eval. and feedback which take another 3-5 days, 5/4 - 5/7. Would it be correct to assign:
96130/96131 DOS 5/3/2024
96130/96131 DOS 5/7/2024
or
96130/96131 DOS 5/1/2024
96130/96131 DOS 5/4/2024
I see in the CPT book it says upon completion of episode of care, but what I don't under is the DOS the completion of episode of care or do you use the beginning/starting.
 
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