To improve the integration of behavioral medicine with physical medicine AmeriHealth is taking bold steps to make it easier for physicians and other healthcare professionals to make an impact in their community.
In an effort to reduce administrative burden and expand access to behavioral health (BH) services, AmeriHealth Caritas will reimburse claims for E/M services and BH Evaluations, when the level of care warrants the usage of the BH evaluation and documentation supports that these services are separately identifiable, in accordance to Ohio Administrative code 5160-27.03 Appendix A, 5160-27-03.
How this impacts billing:
- If the evaluation meets the 30 minute minimum for the following time based codes: 90832, 90836, or 90838, physicians and other healthcare professionals can bill with them with same day/same physician services rendered for codes 99201-99215.
- If the services do not meet the requirements to bill for E/M and full BH Evaluation, physicians and other healthcare professionals have the option to bill for a higher level E/M code or utilize 90792, in accordance with Centers for Medicare and Medicaid Services guidance: “When a patient is referred with an organic diagnosis and a mental health diagnosis is established, the mental health diagnosis should be billed. If a psychiatric diagnostic evaluation with medical assessment is performed, the physician or other healthcare professional may use CPT code 90792 or an E/M code.”