Question 1

What is HCPCS code C7903?

Accepted Answer

HCPCS code C7903 is "Hopd mntl hlt, grp". Group psychotherapy service for diagnosis, evaluation, or treatment of a mental health or substance use disorder provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service

Question 2

What category is C7903 in?

Accepted Answer

C7903 belongs to HCPCS Category C (CMS Hospital Outpatient Payment).

Question 3

When should I use HCPCS code C7903?

Accepted Answer

Use C7903 when billing for hopd mntl hlt, grp. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is C7903 covered by Medicare?

Accepted Answer

Coverage for C7903 (Hopd mntl hlt, grp) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for C7903?

Accepted Answer

Documentation for C7903 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).