271- EI Billing Codes Notice

This is to inform EI Billing Providers of some changes to billing codes used for certain services. Below are descriptions of the changes:

Ø      EI Billing Providers that bill for family training / team meetings performed by a licensed therapist should use CPT code 96155 for all commercial payers. 96155 is described as a "Health and behavioral intervention service provided to a family without the patient present."

Ø      For payer Healthnow, T1027 and S9445 are not billable codes. Claims billed to Healthnow with these codes will be denied with the following: “Ineligible code, provider cannot bill the patient”. Billing Providers who receive this denial should review their claims to determine if the services were rendered by a licensed therapist – if so, the Provider should resubmit with code 96155.

If you have any questions, please contact the PCG Customer Service Center at (866) 315-3747.