Psychiatric Services: Psychotherapy (CPT 90832-90838)
Top denial/partial denial reasons and high-level results are listed below from each round of JL Psychiatric Services: Psychotherapy TPE reviews that have been conducted thus far by Novitas. If you have questions about your individual results, please contact the nurse reviewer assigned to your review for additional information. Additional rounds of review will be utilized when the targeted topic demonstrates a continued need for review with newly identified providers.
The most common reasons for denial or partial denials are the following:
Incident to Requirements not met - Documentation lacked evidence that the services supported incident to billings:
Services were not performed in an office or clinic setting to support “incident to” billings.
Documentation lacked evidence that the physician or other NPP were providing direct supervision.
Documentation lacked evidence that the physician or NPP performed the initial service and remained actively involved in the course of treatment.
Incident to services were being billed by a provider that was excluded from the provision.
Medical Necessity – Documentation was lacking evidence of therapeutic techniques utilized to perform psychotherapy services.
Insufficient Documentation – Insufficient documentation was provided to support the services as billed to Medicare. Novitas Medical Review makes multiple attempts to correct these error types before completion of the review. Below are the following denial reasons for insufficient documentation that we were not able to resolve:
Incorrect rendering provider – The documentation submitted did not support the rendering provider that was billed on the claim.
Incorrect beneficiary – The documentation submitted for review did not support the beneficiary billed on the claims.
Incorrect Date of Service – The documentation submitted did not support the date of service billed on the claim.
No response to Additional Documentation Requests (ADRs) – Documentation was not submitted to Novitas in a timely manner in order to support the services billed to Medicare.
Billing Errors - Upon receipt of the ADR request, the provider deemed the service was billed in error to Medicare.
Round Results
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