Can psychologists bill Evaluation and Management Codes to report these services to Medicare and private insurance plans?
Psychologists cannot bill Evaluation and Management (E&M) codes when treating Medicare beneficiaries because the Center for Medicare and Medicaid Services (CMS) currently restricts the use of these codes. CMS restricts the use of E&M codes to physicians because it is the agency’s position that these codes involve services unique to medical management such as medical diagnostic evaluation, drug management, and interpreting laboratory or other medical diagnostic studies. Although there are some similarities among the services, the health and behavior codes should not be viewed as a substitute for E&M. APA is continuing its advocacy with CMS to permit psychologists to be reimbursed for providing E&M services to Medicare beneficiaries. Psychologists treating patients with private insurance may be able to bill for E&M services because not all insurers impose the same restriction as Medicare. Psychologists should check with the private carrier to determine its policy on E&M.
Psychologists cannot bill Evaluation and Management (E&M) codes when treating Medicare beneficiaries because the Center for Medicare and Medicaid Services (CMS) currently restricts the use of these codes. CMS has taken the position that E & M codes involve services unique to medical management, such as medical diagnostic evaluation, drug management and interpreting laboratory or other medical diagnostic studies. Although there are some similarities among the services, the health and behavior codes should not be viewed as a substitute for E&M codes. APA is continuing its advocacy with CMS to permit psychologists to be reimbursed for providing E&M services to Medicare beneficiaries. Psychologists treating patients with private insurance may be able to bill for E&M services because not all insurers impose the same restrictions as Medicare. Psychologists should check with the private carrier to determine its policy on E&M services.
Related Questions
- Can a healthcare provider be reimbursed for indirect services? Do Medicare, Medicaid, or private insurance pay for indirect services?
- Can psychologists bill Evaluation and Management Codes to report these services to Medicare and private insurance plans?
- How does Highmark Medicare Services review Evaluation and Management Services (E/Ms) billed with the -25 modifier?
