What is changing
If a charge is submitted for an evaluation and management (E/M) service performed as a separate service at the same encounter as a psychotherapy service, and a psychotherapy service is billed without an E/M CPT code, we will recode the charge to the corresponding psychotherapy with E/M CPT add-on code.
Why is Humana implementing this change
According to the AMA CPT manual, when psychotherapy services are performed with E/M services, the psychotherapy is reported by using an add-on code specific for psychotherapy when performed with E/M services.
Providers affected
- Inpatient/Outpatient Facilities
- Physician/Health Care Providers
Plan type
- Select self-funded* products
- Commercial fully insured products
- Medicare Advantage HMO products
- Medicare Advantage PFFS products
- Medicare Advantage PPO products
Disclaimer: Claim edits do not supersede the necessity to obtain preauthorization. Preauthorization requirements still apply. Modifiers should be used when appropriate to accurately represent the services rendered. Please note that this notification may not describe previously implemented rules that still apply; the intent is to give notice of an upcoming change.
If requested by the self-funded group, all code-editing rules posted on Humana.com/edits for fully insured commercial Humana members also may be applied to self-funded members.