Health Information Management

Q&A: Charging for behavioral therapy in the home setting

JustCoding News: Inpatient, September 30, 2009

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QUESTION: I have a question regarding behavioral health treatment sessions. Can a physician or licensed therapist (e.g., LPC or LCSW) provide therapy to a client at the client’s home and then charge this service to the insurance company?

ANSWER: The answer depends on the third-party payer. For nonphysician professionals, coders would most often report HCPCS Level II codes. Refer to codes H0001–H2037 (Behavioral health/substance abuse services). Note that codes in this section cover a much wider scope of therapy than the heading implies. Report place of service code 12 (Home). Check with payers to determine whether they accept these codes. Also, note that CPT code 99510 (Home visit for individual, family, or marriage counseling) is used to denote services provided by a nonphysician healthcare professional.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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