Marilyn Posted Tue 29th of January, 2019 13:14:15 PM
Isn't "90889" for preparing reports only and would not be paid separately by Medicare. We are still having issues with Humana. Original contract was terminated which had the Psychotherapy codes of "90791, 90837 90834" when ABA rates were ammended to the contract..90889, H0031, H0032, H2012, H2019. There are no c odes to bill Medicare Advantage claims from, but Humana reps are still insisting to use the above codes. Are we possibly missing something here for our Medicare Advantage members?
SuperCoder Answered Wed 30th of January, 2019 03:36:23 AM
Thanks for your question.
Most of the payers including Medicare do not provide separate reimbursement for 90889 since they consider this code to be an incidental service that is not separately payable. Instead, they consider payment for this service to be “bundled” in payment for other services, such as 90791 and 90792. The National Correct Coding Initiative edits bundle 90889 into 90791 and 90792 and do not permit a modifier to override the edits. Some payers might provide payment for this code in certain situations, so you can check with individual payer about the situations in which you will receive payment for this code. For instance, you can sometimes charge for preparation of a report to the patient if the report is being used for the benefit of the patient in a legal situation. As noted in the code descriptor, code 90889 is for use when preparing a report for some other individual’s or entity’s benefit, not for physician’s own documentation purposes.
Since, as per the documentation above Humana is not considering psychotherapy code 90791, 90834 and 90837. Therefore, Humana may allow codes like 90889, H0031, H0032, H2012 and H2019. Please check with payer policy regarding the codes H0031, H0032, H2012 and H2019 as they are not payable by Medicare.
Hope this helps.