IGG Posted Thu 21st of July, 2016 15:00:56 PM
Medicare part B seems to cover "establishment of a treatment plan", diagnosis, and "patient education regarding diagnosis and treatment" in a substance abuse treatment setting. Can u advise as to the billing codes and reimbursement rates for these services, and where I could find additional information as to the documentation needed to meet these billing requirements? thank you.
SuperCoder Answered Fri 22nd of July, 2016 02:08:10 AM
Please note that you may use these 2 codes for this condition: 99408 and 99409. Code status of these codes is “N” which means “Non-covered Services". These services are not covered by Medicare. So, for a Medicare patient, you may use the codes G0396 - Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes; and G0397 - … greater than 30 minutes. The RVU values for these codes would be 1) G0396 = 1.01 (Nonfacility) and 0.95 (Facility); and 2) G0397 = 2.01 (Nonfacility) and 1.94 (Facility). Please refer to the following link to identify the documents requirement for billing these codes: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/SBIRT_Factsheet_ICN904084.pdf
Hope this helps!