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March 24, 2006
 
 
MEDICAID INFORMATION RELEASE MA06-05
 
 
TO:                 Physicians
 
FROM:           Leslie Clement, Deputy Administrator
 
SUBJECT:     NOTICE OF PHYSICIAN BILLING INSTRUCTIONS
 
Due to HIPAA (Health Insurance Portability and Accountability Act), changes were made in Idaho Medicaid’s MMIS (Medicaid Management Information System) October 20, 2003 which required that physicians bill with specific modifiers in order to get paid a physician reimbursement rate vs. a mid-level reimbursement rate.
 
The following table outlines the procedure codes that were affected by this change.
 
HCPCS or CPT Code
Modifier
Description
90804
Use UA modifier if performed by physician
Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient
90806
Use UA modifier if performed by physician
Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 40 to 50 minutes face-to-face with the patient
90808
Use UA modifier if performed by physician
Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient
90810
Use UA modifier if performed by physician
Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient
90812
Use UA modifier if performed by physician
Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient
90814
Use UA modifier if performed by physician
Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient
90847
Use UA modifier if performed by physician
Family Psychotherapy (conjoint psychotherapy with patient present)
90853
Use UA modifier if performed by physician
Group Psychotherapy (other than of a multiple-family group)
 
To make adjustment to claims that have already been submitted, please void each claim, and then resubmit the claim. 
 
If you have any questions concerning the information contained in this release, please contact Sheila Pugatch, Principal Financial Specialist for the Bureau of Medicaid Policy, at (208) 364-1817.
 
Thank you for your continued participation in the Idaho Medicaid Program.
 
LC/sp/jr