Q. Will Medicare pay for a conference with a patient's guardian without face-to-face contact with the patient? In this case, our patient suffers from dementia, and the physician needs to speak with the guardian and family about the patient's care, without the patient in the room.
A. Medicare policy does not allow payment for visits with the family when the patient is not present, except for family psychotherapy services.
Under its Psychiatric Codes local coverage determination (LCD), TrailBlazer Health Enterprises, the Medicare Administrative Contractor for Texas, will consider payment for codes 90846 (family psychotherapy without the patient present) and 90847 (family psychotherapy with the patient present) only for treatment of the Medicare beneficiary's mental illness.
According to TrailBlazer:
- Family therapy is appropriate when intervention in the family interactions would be expected to improve or stabilize the patient's emotional/behavioral disturbance. Medicare will not cover family therapy sessions with a patient whose emotional disturbance would be unaffected by changes in the patterns of family interaction (e.g., a comatose patient).
- An emotional disturbance in a family member, which does not affect the Medicare patient's status, would not be covered by that patient's Medicare benefits.
- Family therapy is commonly the major treatment, especially for children and also for the elderly.
- Where both husband and wife are covered by Medicare, such therapy may be the most cost-effective treatment for both.
- Code 90846 does not represent routine consultation with staff about the patient's progress and treatment. Facility staff members are not considered "caregivers" under the LCD; however, caretakers in group-living facilities may be considered caregivers under this policy.
Code 90849 (multiple family psychotherapy) generally is not covered. Such group therapy is directed to the effect of the patient's condition on the family and does not meet Medicare's standards of being part of the personal service to the patient. If such is not the case, you may submit individual documentation for consideration.
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