Billing for code 90887

We have a nurse practitioner who has taken a course for billing ADHD and scoring evaluations. I am getting denials for this saying she is not credentialed for this code. However on the list I have it says Primary care clinicians? Can you tell me if she should be able to bill this code for scoring?

it's tricky

Behavioral health is really insurance dependent. They set up edits so that only certain providers can bill certain codes, and tis fits that. They do not want a PCP telling a parent- "your kid has ADD" and charging a code that includes specific testing/counseling. So you may need to call your provider reps and get a special dispensation

90887 Medicare

Payment for the one code available for counseling services, 90887, has been bundled into other medical services under Medicare and is not billable to anyone - the patient or the family member, even with a signed waiver of liability. Code 90887 (consultation with family) provides for the "interpretation or explanation of results of psychiatric, other medical examinations and procedures...to family or other responsible persons, or advising them how to assist patient." CMS's stance is that when billing for counseling, the main focus has to be the treatment of the illness of the Medicare beneficiary.