Medicare Improper Payment Report for Behavioral Health Services (2014)

Improper Payment Rate

Type of Error

33.9%

24.4%

21.0%

26.4%

In an effort to review data for billing practices, patterns or trends, Noridian Government Services commenced a process of reviewing psychiatric claims.  It includes the following CPT Codes:

90801, 90804, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90862

The Review Results indicate:

Review results indicate a 28 percent denial rate of claims submitted with 90862. The documentation submitted supported dispensing medications and giving injections.  Procedure code 90862 (pharmacological management, including prescriptions, use and review of medication with no more than minimal medical psychotherapy) should not be used for the following purposes:

• Dispensing medications
• Giving injections
• Filling medication boxes for patients
• By non-practitioners as ‘incident to’

Non-physician practitioners are required to submit claims using their own Provider Identification Number (PIN), if the CPT code 90862 is within their scope of practice.

Review results also indicate 7% of reduced or partially paid claims submitted with the CPT Code 90862; the documentation actually supported M0064.