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Question: We are not able to get any payers to cover 3085F when billed with an office visit. Why is that?

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Answer: Some payers may have 3085F (Suicide risk assessed (MDD, MDD ADOL)) listed on their fee schedules, but Medicare and most commercial payers do not. That鈥檚 because 3085F is a Category II CPT^庐 code. Category II codes are optional, unless required by your payer contracts, and intended for measuring performance on quality metrics, not for reimbursement.

Or, as the American Medical Association (AMA) says that CPT^庐 Category II codes, they are 鈥渟upplemental tracking codes that can be used for performance measurement. The use of the tracking codes for performance measurement will decrease the need for record abstraction and chart review, and thereby minimize administrative burdens on physicians and other health care professionals鈥� ().

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If your provider assessed the patient using tests such as Home, Education, Eating, Activities, Drugs and Alcohol, Suicide and Depression, Sexuality and Safety (HEEADSSS), then reimbursement is an option with code 96160 (Administration of patient-focused health risk assessment instrument [eg, health hazard appraisal] with scoring and documentation, per standardized instrument) 鈥� a health risk assessment (HRA) code 鈥� to assess how a psychological condition is affecting a patient鈥檚 physical condition. You鈥檒l report that code when the provider assesses how a mental health condition is affecting, or can potentially affect, a patient鈥檚 physical health.

As always, if the notes are unclear regarding what occurred during any office visit, query your provider for additional details.