I have a Blue Cross health plan that will either pay 50% or 90% for mental health depending on
the billing code. My son and daughters counselors and psychiatrists have been using 314.01 which is paid at 50%. Blue Cross says there are different codes that can be used which pay more but they can't tell me what they are. Has anyone else encountered this problem?
Hi Mitch:
You are talking about a diagnosis code of ADHD. If your children have other diagnoses that a professional has given them, such as depression or anxiety, BC/BS may pay more. On the other hand, they often assign payment according to the treatment code, rather than the diagnosis code. Treatment codes for psychotherapy or other treatment vary according to your State's BC/BS payment schedule. They also vary according to what level the provider is, for instance, a LCSW will not get as much as a Ph.D. and a Ph.D., does not get as much as an M.D.
I hope this helps,
Dr. Diana Walcutt
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