ADD/ADHD Medical Billing Reimbursements

Attention providers, are you getting reimbursed for your medical billing ADD medication rechecks? With the rise of ADD/ADHD in America, it is very important to medical practices to understand how to get paid. When dealing with mental health diagnoses, you walk a fine line with most insurance companies. There is one way most payers will reimburse your ADD/ADHD medical billing.

Most physicians like to code ADD medication rechecks with the 90862 medical billing code. This code means, pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy. Although there is no problem using this CPT code with the diagnosis 314. (Hyperkinetic syndrome of childhood), many payers will deny the claims.

A set of codes that payers typically pay for physician ADD med checks is 99212-99215. These are evaluation and management codes. Many times the medical billing systems send up red flags in payers’ offices because it comes through as a mental health diagnosis. If your physician doesn’t have a mental health specialty, that payer may deny your medical billing claim. This may be because the mental health plan is carved out.

Not only do evaluation and management codes get paid more quickly in ADD medical billing, but they are also more descriptive of the service provided. When a provider does a medication recheck, many times the patient is also evaluated to see if the medication is still working. The 99212-99215 medical billing codes reimburse more accurately for that service.

If your ADD medical billing is still being denied with evaluation and management codes, it may not be your coding. Some insurance plan will not pay ANYTHING with a mental health diagnosis. Sometimes absolutely every aspect of mental health is carved out. Either they have a different mental health carrier, or you will have do redirect your medical billing to the patient. Make sure you cover all your bases in medical billing before surrendering to this ADD solution.

View all Articles by: Melissa Clark, CCS-P