IGG Posted 2 Year(s) ago
Under Medicare Part B, within an outpatient substance abuse treatment clinic, can individual counseling sessions between a licensed counselor and a patient be billed to Medicare (if the treatment plan is supervised by a physician), and if so what code would be used, what is the expected reimbursement rate, and with what maximum frequency could these sessions be billed (i.e., per month?)? Thank you
SuperCoder Posted 2 Year(s) ago
Thanks for your question. Please note that you may use these 2 codes for this condition:
1) 99408 - Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
2) 99409 - … greater than 30 minutes
Code status of these codes is “N” which means “Non-covered Services. These services are not covered by Medicare.”
Guidelines: (Behavior change interventions are for persons who have a behavior that is often considered an illness itself, such as tobacco use and addiction, substance abuse/misuse, or obesity. Behavior change services may be reported when performed as part of the treatment of condition(s) related to or potentially exacerbated by the behavior or when performed to change the harmful behavior that has not yet resulted in illness. Any E/M services reported on the same day must be distinct and reported with modifier 25, and time spent providing these services may not be used as a basis for the E/M code selection. Behavior change services involve specific validated interventions of assessing readiness for change and barriers to change, advising a change in behavior, assisting by providing specific suggested actions and motivational counseling, and arranging for services and follow-up).
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