billing codes

How To Handle Unlisted Codes To Prevent Denials

The healthcare industry continues to evolve with new services, care devices, medications, and treatment techniques being developed each day. These advancements are entering the field faster than ever before. Many of them have new CPT codes affecting their use and applications. Yet the American Medical Association (AMA) can sometimes take as much as 18 months to 2 years to come out with modified CPT codes and instructions for some of these new advancements. This can lead to a plethora [...]

By |August 26th, 2022|Categories: Tips|Tags: , , |0 Comments

Code 97157, 97158 in ABA Therapy. How & When To Use Them

A Bevy of new CPT codes took effect on August 1st of 2021. Many beneficiaries are not eligible for these new codes until their next authorization period after that date. Two of the most common and critical codes affected include the following CPT codes. 97157 - multiple family group adaptive behavior treatment guidance 97158 - group adaptive behavior treatment with protocol modification This can include up to 8 families for up to 6 units, which translates into 1.5 hours [...]

By |April 28th, 2022|Categories: Tips|Tags: , , , |0 Comments

99211 CPT Code Use Case Scenarios For ABA Therapy

CPT codes play a critical role in medical billing. Using the wrong code in the wrong place or for an incorrect type of diagnostic or treatment process can lead to potential claim rejections and denials. Not to mention a very serious risk of delays in your practice’s revenue stream. One of the CPT codes that come under scrutiny by some insurance providers and public health institutions is the 99211 CPT code. Though knowing precisely when to use this 99211 [...]

By |January 18th, 2022|Categories: Tips|Tags: , |0 Comments

When To Use Place Of Service Codes In Behavioral Health?

It seems like medical billing codes are constantly being tweaked, changed, or redirected in how they can be used. For a small practice or solo practitioner it can feel very much like a hassle to keep up with them and all the changes in minutia codes like the place of service codes. The truth is, providers everywhere frequently struggle to memorize billing codes that always seem to change. Yet it remains true that the proper use of all these [...]

By |January 16th, 2022|Categories: Tips|Tags: , |0 Comments

What Are Medically Unlikely Edits / MUE for ABA Billing?

Medically Unlikely Edits, which are often referred to in the medical billing industry as “MUE” are used by public health institutions like the Medicare Administrative Contractors, the Durable Medical Equipment, and similar institutions to help reduce the improper payment rate for a wide range of Medicare Part B claims. An MUE for an HCPCS/CPT code is essentially the maximum number of units of service that a provider can report for a single beneficiary on a single date of service. [...]

By |October 20th, 2021|Categories: Tips|Tags: , |0 Comments
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