Billing pointers and FAQs

Tips to keep in mind when billing Medicare and other payers for services

by Government Relations and Legal & Regulatory Affairs Staff

August 31, 2010 — Psychologists who attended the American Psychological Association’s 2010 convention in San Diego August 12-15 had the opportunity to attend a workshop titled, “Reimbursement 101: Resources for Our Members.”  The presentation included several pointers for psychologists to keep in mind when billing Medicare and other payers for services, along with answers to several common billing questions.

Six billing pointers 

  1. Whether you are dealing with a public program or private sector insurance plan, know the payer’s coverage policies such as pre-authorization requirements and restrictions on the number of hours that may be billed for a particular service. Medicare Administrative Contractors have websites that contain these policies, as do many private insurance carriers.

  2. Use essential billing tools to help you code properly. Two of the most important billing tools are the CPT® procedure codes and the ICD-9-CM diagnosis codes. Tip: CPT code information is available through the American Medical Association’s (AMA) website, which includes a search function that allows a limited number of free online searches for code numbers and provides the Medicare payment rate for each code based on geographic area. Information on how to access the ICD-9-CM codes can be found on the website of the Centers for Disease Control. In addition, books containing the CPT codes and the ICD-9-CM codes can be purchased through the AMA’s website. 

  3. Make sure that the entire claim form is completed accurately. For example, the patient’s name should match the way it appears on his or her Medicare or other insurance card.

  4. Document every patient encounter in the record, and be sure to note start and stop times for timed services such as psychotherapy. From the carrier’s standpoint, if you don’t record a service, you didn’t provide it. Your documentation should reflect patient progress in light of his or her treatment plan.

  5. File claims promptly after delivering services. Doing so helps minimize the time between service delivery and reimbursement and is particularly important for your practice finances if your claim is rejected and must be re-filed.

  6. Have a process for tracking claims and appealing denials. Make sure appeals are filed on time for denials you believe are improper.

Four common questions from psychologists

Q. Do I need to first enroll as a Medicare provider in order to opt out and privately contract with Medicare beneficiaries?

A.  No, enrollment as a Medicare provider is not required for anyone seeking to opt out. Any psychologist interested in doing so must file an affidavit with the regional Medicare Administrative Contractor agreeing not to submit any claims to Medicare for at least a two-year period and meet other criteria. For more information about opting out and privately contracting with Medicare beneficiaries, visit the Guidance from CMS on Contracting Privately to Provide Medicare Services page.

Q. How do I bill for a 60-minute psychotherapy session?

A. Use the 90806 code (45-50 minutes of in-office psychotherapy) + Modifier 22 to indicate that this service was provided for an extended time. On the CMS 1500 form, the code goes in the box in the column labeled CPT/HCPCS, while the modifier should appear in the column directly to the right labeled MODIFIER.

Q. How do I bill an insurer for follow-up related to patient testing and assessment?

A. It depends on the predominant service provided. Medicare and most private insurers will pay only for one service provided to a patient on any particular day.

Here are a few possible scenarios:

  1. You spend the session providing feedback about the test results and discussing them with the patient. You would bill additional units of 96101 (psychological testing by a psychologist, per hour) or 96118 (neuropsychological testing by a psychologist, per hour) beyond whatever time you have already spent for testing, interpretation and report preparation.

  2. In a follow-up session with the patient, you spend 15 minutes discussing test results followed by 35 minutes providing psychotherapy relative to those test results. To reflect the predominant service provided, you would bill 90806 (45-50 minutes of in-office psychotherapy.)

  3. After reviewing test results, you spend the majority of time helping a patient learn coping skills due to brain injury or other physical limitations. You would bill using 96152 (health and behavior intervention, in 15-minute units). 

Q. How do I bill for psychotherapy provided by telephone?

A. At this time there is no code for providing psychotherapy services by telephone.  While there is a code for an unlisted psychiatric service (90899), it has no reimbursement value in the Medicare fee schedule. Psychologists billing private insurance should check with the carrier to determine if services provided by telephone are reimbursable – generally, they are not.   


Current Procedural Terminology (CPT®) copyright 2010 American Medical Association.  All Rights Reserved.