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Clarification on Psychotherapy Billing
From:
Sent:
To:
Passport Health Plan
May 22, 2015
Passport Community Based Behavioral Health Providers
Background:
This communication clarifies billing directives published by the Kentucky Department of Medicaid Services. These changes
are effective April 1, 2015, and are necessary to be compliant with the National Correct Coding Initiative (NCCI).
Historically, Code 90837 (Psychotherapy) was billed in multiple units to indicate that multiple hours of individual
psychotherapy had been provided on the same day. Based on clarification from the Kentucky Department of Medicaid
Services, Code 90837 is now used for the first hour of individual psychotherapy. Code 99354 is used to reflect individual
therapy services that have exceeded 90 minutes and up to two hours in the same day. Code 99355 is used for each
additional 30 minutes beyond two hours and up to three hours in the same day.
Codes 90846 and 90847 (Family Psychotherapy) are event codes and may only be billed once per day. These codes are not
affiliated with a time limit.
Code 90853 (Group Psychotherapy) and Code 90887 (Collateral Therapy)are also event codes and may only be billed once
per day. These codes are not affiliated with a time limit.
Provider Action Needed:
Please do not submit any new claims to become compliant with these directives. Please submit corrections to previously
submitted and paid claims for these impacted services via eServices.
This information was previously communicated through Passport eNews on 02/19/15. We hope these additional
instructions aid in reducing any confusion around the process.
Once the corrected claims have been filed, any additional funds owed to the provider or funds that will need to be
recouped by Passport Health Plan will occur during your next scheduled payment following the corrected claim submission.
Please refer to the Claims section (slides 73-78) of the Behavioral Health Overview presentation located on Passport’s
website for information on submitting and correcting claims.
Thank you for your assistance in helping us to comply with the new directives regarding these billing codes.
Questions:
If you have any questions, please contact your Behavioral Health Provider Representative or e-mail us at
[email protected] .
©2015 Passport Health Plan (PROV51317)