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Psychiatric eval 90791 and Psychological testing 96101

Our Psych providers are posing the below question.

90791 – Psychiatric diagnostic evaluation
Providers currently bill 90791 for an initial intake appointment. This is when the providers are gathering information from the parents regarding their concerns. Outside of the appointment, the parents complete questionnaires and measures to help the psychologists determine what diagnostic testing may be appropriate.

If testing is warranted, they then bill 96101 for the testing/evaluation and the subsequent time it takes to analyze, write the reports, etc. An authorization for this service is often required and they may request up to 8 hours for it.
96101 – Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologist’s or physician’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report

Our question is since the 90791 is broad, what would keep them from being able to bill 90791 for the testing and then 96101 for the time it takes to interpret the results and write the report?
Can anyone offer any insight??

Medical Billing and Coding Forum

How to quote abort services for pscyh testing 96101 is modifier 52 appropriate to use


I have to bill for psych testing-96101 that doctor/psychologist had to abort because patient wouldn’t participate at all, she spent 2 hours on it reviewing notes, talking to the parents, observing a patient and DI-90791 was done on a different date as well, so I was wondering if using modifier 52 with this procedure code would be appropriate? We have to get paid at least a little bit for doctor’s work. Thanks so much

Medical Billing and Coding Forum

Reference Laboratory Testing

Medicare states that when performing laboratory test by both the billing laboratory and a reference laboratory, you are not to split the claim. You distinguish the test by using modifier 90 for the tests that were referenced out. My question is who’s information goes in box 31 and 32 on the 1500 form? The billing laboratory or the the reference laboratory?

Medical Billing and Coding Forum

95004 Allergen Testing Clarification

1. When testing for 260 different allergens, but only doing 96 pricks (the allergenic solutions have multiple allergens in each of them), would the patient be billed for 96 or 260 units? Is there guidance you could point me to?

2. What qualifications must an individual possess to administer this test, record the results, and prescribe treatment? Again, is there guidance you could point me to?

3. Are there time or quantity restrictions on this code?

4. Over what period of time would the allergen tests apply … for life? For 5-10 years?

Medical Billing and Coding Forum

69210 and audologic function testing

Our encoder shows that it is OK to bill cerumen impaction removal (69210) and an comprehensive audiometry threshold evaluation and speech recognition (92557) and tympanometry (92567) on the same DOS. However, an insurance company (BCBS) has performed an audit and is taking the money back for the 69210 stating it is bundled. I cannot find any concrete information to show that the 69210 is actually bundled with the testing. (except for one sentence on[/URL]) Can someone point me in the right direction?



Medical Billing and Coding | AAPC Forum

Allergy Skin Testing Modifier

I filed a claim for 99213-25; 95117; 95004 and 95024. The insurance company denied the allergy skin testing codes (95004 and 95024) because of the 95117 code saying it was bundled. Should I use modifier 59 with 95004 and 95024? (Patient came in for allergy skin testing. Allergy extract was made that day and then shots administered.)

Medical Billing and Coding Forum | AAPC