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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Employee (Participant) Information section. Clearly type or print your last name, first name, middle initial, home address, social security number, and contact numbers. Ensure accuracy as this information is crucial for processing.
In the DeCAP Reimbursement Requests section, list each dependent's name and provide all dates of service. Make sure these dates are prior to when you sign the form. Specify the type of service provided and enter the reimbursement amount requested.
For each service listed, include the provider’s name and address along with their federal tax ID or social security number. This information is mandatory for reimbursement processing.
Finally, sign and date the form in the Employee (Participant) Signature section to confirm that all information is accurate and complies with DeCAP rules.
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CPT Code 99404 Reimbursement Rate Reimbursement for 99404 by Cigna tends to be similar to routine sessions, like 90834 or 90837. Because all sessions billed as 99404 are EAP, they should not have any patient responsibility.
What is CPT code 99404 for EAP?
Employee Assistance Programs (EAPs) are billed to the normal payer using a special service code. For example, if the EAP is under Aetna, bill to Aetnas normal payer ID using the EAP service code. If you dont know the service code to use, contact the payers EDI department directly.
What is the CPT code for EAP?
81001 automated, with microscopy. 81002 non-automated, without microscopy.
What is the difference between CPT code 81001 and 81002?
CPT code 99404 is a specific billing code used by healthcare professionals to document and charge for individual, intensive counseling sessions aimed at helping patients quit tobacco use provided these sessions last more than 10 minutes.
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Instructions completing the eap case activity and billing form pdfInstructions completing the eap case activity and billing form 2021
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Reports: Collect and present printer data in a number of formats with complete transaction and summary reports designed for Excel or other custom billing
Employee Assistance Program Case Tracking System (
The EAP counseling personnel use the information to facilitate general case-management activities for ongoing EAP cases, as well as to produce high-level,.
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