Many practices report they are experiencing denials when billing services for attention-deficit disorder (ADD) (314.00) and/or attention-deficit/hyperactivity disorder (ADHD) (314.01). Unfortunately, some health plans do not cover behavioral or mental health–related services, or they consider these services carve-outs. A carve-out arrangement, in this case, means that all care for patients with these diagnoses would be provided only by mental health specialists. As the diagnosis codes for ADD and ADHD fall in the International Classification of Diseases, Ninth Revision, Clinical Modification range of mental disorders (290–319), carriers assume these services must be provided by a mental health professional, or they are not covered.

It is important to meet with carriers to educate them on the scope of services provided, the time requirements for the service, and the benefits when the pediatrician provides the services. Take this opportunity to demonstrate cost savings that may be recognized by the plan. Try to...

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