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Billing For Diabetes Management (Exemplar Topic)
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8/28/2017 at 2:39:11 PM GMT
Posts: 15
Billing For Diabetes Management (Exemplar Topic)
Hello Colleagues -
If you work in an FQHC, could you share what CPT / diagnostic codes you are using for diabetes management for those patients who do not present with depression or anxiety or other related BH issues?
Thank you 


If we're not treating a mental health condition (or not one that meets full diagnostic criteria) and the session is focused primarily on disease management, we use F54 ("Psychological and behavioral factors...") along with the relevant diabetes code (eg E11.*) and then an appropriate psych CPT code (eg 90791, 90832). We also use that combination for patients with diabetes distress, or for patients with a new diabetes diagnosis who are learning to adjust to diabetes but don't have an adjustment *disorder*. You could try to use the H&B CPT codes, but I feel like many states don't reimburse them.

I would be mindful about billing mental health codes if the session is primarily focused on a medical condition. I could definitely see a payor causing a fuss if I spent the session treating diabetes and then billed for depression even if the patient has both diagnoses. We've been mindful to keep the billing code tied to what happens in session, and haven't had a problem getting reimbursed. It also allows patients to see a psychologist without having a "mental health" diagnosis added to their record, which I think greatly helps integration both from the patient and medical provider perspectives.


We use the Health and Behavior Codes (96150/52...) for billing with the DM medical diagnosis.


Same here. 96150 for 1st visit and 96152 for follow-ups.....2 units when needed as each unit is only 15 minutes 


Thank you all again for the helpful feedback and guidance. It is truly appreciated. 

Neftali Serrano, PsyD
Executive Director, CFHA &
Fan of All Things Integrated Care

1/9/2018 at 7:39:04 PM GMT
Posts: 1
We also use health and behavior codes, 96152, 96153, 96154.

Denise Dart, Psy.D.
Community Health Connections, Tulsa, OK

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