CPT Codes
What code is utilized to bill an initial session with a client?
90791
What should you have in every client's chart before they come in for their initial appointment to ensure you are able to collect copays/balances?
Debit or credit card
HSA or FSA
*Plan type: Preferred Provider Organization (PPO)
*No additional payer information provided.
*No auth needed for routine services.
*Mental health services should be covered 100%*
$0
What code is used for ongoing individual sessions (53+ min long)?
90837
What percentage does a self pay patient owe you at the time of their appointment?
100%
Coverage: Active
Payer/Plan Type : CIGNA/Choice Fund HRA Open Access Plus
Copay: $30
$30
What differentiates an in person session code from a virtual session code in Valant?
the letters: TH
What do you do when you discover your patient owes more than their copay?
Accepted answers:
Collect it all at time of service.
Call them ahead of time to discuss.
Make a plan with client to get caught up.
Double Jeopardy!!!
You receive this email from verifications:
Coverage: Active
Payer/Plan Type: BCBS of South Carolina/PPO
Copay: No copay found. Possible deductible/coinsurance plan. The payer will determine the client’s responsibility once the claim is processed, and the information is returned on the explanation of benefits. Please refer to your clinic’s policies on collection of potential client responsibility.
90791: $118
90837: $100
What code would be used if a family member or loved one joins your client's session to enhance the work or treatment of your client?
90837
DOUBLE JEOPARDY!!!
What can you do if something looks funky on your end regarding patient copays or balance?
1. connect with Nikki (or Laurie)
2. submit a fresh service ticket
If you do not collect a copay or patient responsibility fee, who is responsible for collecting it later?
You!
And Nikki sends out statements and collections down the road but it becomes increasingly difficult to collect when someone has a high balance, the balance is months old and/or that patient is no longer being seen.
What code should be used if a family member or loved one joins your client's session and the focus is the treatment of the family unit as a whole?
What code would be used if the patient is NOT present?
90847
90846
If your session exceeds 60 minutes, how much will insurance reimburse you for your time?
$0
Double Jeopardy!!!
Copay: $25.00 per session
Ind OOP: $3,000/$2,314.84 Remaining
Fam OOP: $6,000/$3,370.92 Remaining
*Plan type: Preferred Provider Organization (PPO)
*No additional payer information provided.
*No auth needed for routine services.
*Mental health services will NOT be subject to a deductible or a coinsurance. The copay is required until EITHER the individual or family out of pocket maximum (OOP) has been met.
1. how much will you collect?
2. how much will you collect once the deductible has been met?
3. how much will you collect once the OOP max has been met?
1. $25
2. $25
3. $0