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2x 90806 in one week

Elliott Posted Wed 13th of July, 2011 19:06:35 PM

I have a medicaid patient that has two 90806 sessions scheduled in one week. Is there a modifier that I can use to bill both sessions...something like if it were an emergency or something. Thank you!!

SuperCoder Answered Thu 14th of July, 2011 04:57:08 AM

The MUE for 90806 is 1. So, logically we can bill 90806 twice in a week. But, it has been a recent phenomena that most Insurance companies thought this procedure being unreasonably billed multiple times and started throwing denials on this CPT.

So, reimbursement depends on:
1. contact your insurance for knowing the proper reason.
2. submit documentation and evidence in support of medical necessity.
3. ask what is acceptable frequency for this cpt by the Insurance companies, and accordingly schedule such procedures or sessions.

Elliott Posted Thu 14th of July, 2011 14:13:33 PM

Thank you for the reply and information!

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