Thursday, August 08, 2013

Continued Problems w/ Using Health & Behavior Codes 96152 under New NC Medicaid Management Assoc w/ LME's

Here is a letter to the head of Claims at Smoky Mountain Center LME.  If anyone has any information about how to hack through this, given that there is no more Value Options managing NC Medicaid, please let me know.  Thank you:

Marsha V. Hammond, PhD, Licensed Psychologist, NC
e mail:

RE: MEDICARE code 96152 which wrapped around to NC Medicaid psychotherapy code e.g., 90806, etc.

Date: August 8, 2013

Dear Mr. Tax, head of Claims at SMC LME: 

Thank you for contacting me.  I KNOW that 96152 is not in my SMC contract.  It has NEVER been a Medicaid code.  It is a Health & Behavior code, put into use by the American Psychological Association in conjunction w/ discussions w/ CMS in 2000.  I have used it for years without the issues that are plaguing me as associated w/ SMC LME. 

If I could turn up my old Medicaid RA's, which are now unavailable as Value Options no longer manages any part of NC Medicaid, via the NC webclaims site, I could print them out and send them to you.  I do not keep my RA's from previous years.  

As I stated before, prior to the LME's taking over Medicaid, this is what would happen when I submitted a 96152 MEDICARE code for dually eligible clients.  NOTE: This is not what took place re: MEDICAID ONLY clients.  For those clients, I would simply go to NC Medicaid webclaims, submit the (then) 90806 or whatever applicable code and be paid. 

NC MEDICAID VALUE OPTIONS AUTOMATICALLY WRAPPED AROUND for the dually eligible Medicare/ Medicaid clients utilizing the 96152 Medicare code.  HOWEVER, a different psychotherapy code was applied.  I never asked why.  I simply got paid.  

I have contacted as per this e mail Dr. Bert Bennett of NC Medicaid, a psychologist working in Raleigh w/ Behavioral Health to see if he can advise you about this matter.  I have no idea how to contact Value Options and reobtain my RA's so you understand that this is how things occurred for years prior to the LME's taking over NC Medicaid.  

96152 is the most appropriate code for me to use as I interface w/ physicians, psychiatrists, etc., to provide integrated care for my patients who commonly have overlapping medical and mental health issues. 

I left you a voice mail a moment ago.  Thank you for continuing to look into this matter.  

Marsha V. Hammond, PhD


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