Date: 02/05/19 NH Healthy Families would like to notify providers that there has been no change to the Applied Behavioral Analysis (ABA) codes for NH Healthy Families Medicaid ABA services. CPT® codes and descriptions only are copyright 2019 American Medical Association. Developed by Health Evolutions, Inc., under contract with the Envision fee schedules and rates – on the Envision web portal; Envision fee schedules – downloadable; Envision fee schedules – interactive, look up a procedure code and date of service © Copyright 2021 Centene Corporation. If the assessment requires more time than the initial 30 minutes, use code 0361T. Effective January 1, 2018 the Department of Community Health (DCH), Medicaid Division, will provide coverage for Autism Spectrum Disorders (ASD) services for individuals under the age of 21. 2 | APPLIED BEHAVIOR ANALYSIS (ABA) PROGRAM BILLING GUIDE Disclaimer Every effort has been made to ensure this guide’s accuracy. MEDICAID BILLING TOOL KIT. $307.35: Per Assessment Once per year: T1024: TJ: Evaluation and treatment by an integrated, specialty team, contracted to provide coordinated care to multiple or severely handicapped children, per encounter: 97151 TJ: Behavior identification re-assessment, limited to 2 units per six months: $36.06: Per 30 minutes Date: Florida providers must be enrolled as Provider Type 39 with Florida Medicaid to bill for dates of service starting February 1 and providers must use the new BA billing procedure codes. View up to date information on how Illinois is handling the Coronavirus Disease 2019 (COVID-19) from the State of Illinois Coronavirus Response Site. For dates of service prior to January 1, 2019, claims must be billed with the 2018 version of CPT® and HCPCS codes and modifiers. Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims … ASD coverage is provided for assessment and treatment services according to severity and is based on medical necessity. Billing Code Descriptors Billing Code CPT® Descriptor 97151 Behavior Identification Assessment, administered by QHP, each 15 minutes of QHP’s time face-to-face with patient and/or guardian(s)/caregivers(s) administering assessments and discussing findings and ABA designated codes except H0031 Other ABA Designated codes = 97151, 97152, 97154, 97155, 97156, 97158 $ 5.50/unit 2019 CPT Code: hou 97154 ((replaces H2014U5) combin designated codes RBT/BAT PA Required; Other ABA Designated codes = Face to Face 97156, 97158 Group Code 1:2-3 patients → ABA Group Adaptive Behavior Treatment • Direct ABA treatment Eight new Category I CPT codes for ABA services were approved, and two Category III codes were revised. Phone: 602-417-4000 In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) Fee schedules and rates; Provider Billing Handbook; Envision. » Medicaid Policy and Quality, © 2021 Florida Agency for Health Care Administration, Managed Care Policy and Contract Development, Medical and Behavioral Health Coverage Policy, Quality Performance Review and Applied Behavior Analysis . NH Healthy Families would like to notify providers that there has been no change to the Applied Behavioral Analysis (ABA) codes for NH Healthy Families Medicaid ABA services. If an actual or apparent conflict between this document and a Health Care Authority (HCA) rule arises, the rule applies. Download the free version of Adobe Reader. Group (DRG) guidelines, Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (CCI) Policy Manual, CCI table edits and other CMS guidelines. Autism Speaks has worked for multiple years on the CPT Steering Committee seeking AMA approval of these new codes. The following fee schedules are applicable for dates of service on or after 4/30/2015 through 12/31/2015: Appendix A Local Level Codes & Modifiers. AHCA: About Medicaid. Addendum B, which contains all assigned relative value units (RVUs) for services within the MPFS, clearly indicates that the CPT codes for adaptive behavior (ABA) services (97151-97158, 0362T, 0373T) will remain carrier-priced […] Provider Specific Information Related to billing and reimbursement for services to Medicaid, CSHCS, Healthy Michigan Plan, and MOMS beneficiaries. The additions, changes, and deletions to the therapy code list reflect those made in the applicable year for the Healthcare Common Procedure Coding System and Current Procedural Terminology, Fourth Edition (HCPCS/CPT-4). Appendix S - RA Expenditure Reason Codes (12/18) Appendix T - Community Mental Health Services Program - please review the Uniform Services Coding Manual found on the Accountable Care Collaborative Phase II - Provider and Stakeholder Resource Center under the Uniform Services Coding Standards drop-down menu. Medicaid Fee Schedule 2018 Medicaid Fee Schedule 2017 Medicaid Fee Schedule 2016 . June 20, 2019 . For our Providers: Many recent Provider Notices include information on the Coronavirus Disease 2019 (COVID-19). February 1, 2021 to present - ABA billing guide; December 1, 2020 to January 31, 2021 - ABA billing guide; January 1, 2020 to November 30, 2020 —ABA billing guide; View all ABA billing guides; Fee schedules. It is the standard when billing multiple units of service with timed procedures defined as per each 15 minutes. » Medicaid The purpose of this manual is to provide billing information regarding the implementation by the New York State Department of Health … South Carolina Medicaid managed care organizations (MCOs) will also accept authorization requests and claims using the 2019 Category I CPT codes beginning May 1, 2019. 2019 CPT CODE: 97152 week (no code previously) RBT/BAT PA Required Face to Face 1:1 Service → ABA - Behavior Identification Supporting assessment • Basic assessments administered by a technician working under the direction and supervision of a In the fall of 2018, the AMA’s CPT Editorial Panel announced new codes for ABA billing. The U.S. Department of Health and Human Services (HHS) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus named “Coronavirus Disease … The files on this web page contain the list of codes indicating whether they are sometimes or always therapy services. Appendix B Revenue Center Codes Requiring CPT or HCPCS Coding. The new Category I status should lead to fewer denials of coverage based on reasons that ABA is “experimental” or “not medical in nature.” Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2020 Provider Newsletter) []Attention Behavioral Health Providers: Monthly Behavioral Health Training Assistance (BHTA) Webinar Scheduled [See Web Announcement 2009]. However, Medicaid will update the DME fee schedule in compliance with the required upper payment limit demonstration and publish a new fee schedule effective Jan. 1, 2021. These updates are intended to ensure children receive the right service, at the right time, and by the right provider. Clinical Monitoring, Ambulatory Surgical Center Services Fee Schedule, Behavioral Health Overlay Services Fee Schedule, Child Health Targeted Case Management Services Fee Schedule, Community-Based Substance Abuse County Match Fee Schedule, Community Behavioral Health Services Fee Schedule, County Health Department Certified Match Program Fee Schedule, Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients, Medicaid Certified School Match Program Fee Schedule, Medical Foster Care Services Fee Schedule, Mental Health Targeted Case Management Services Fee Schedule, Occupational Therapy Services Fee Schedule, Prescribed Drugs Immunization Fee Schedule, Prescribed Drugs Oncology Physician Administered Fee Schedule, Prescribed Drugs Physician Administered Fee Schedule, Prescribed Pediatric Extended Care Services Fee Schedule, Private Duty Nursing Services Fee Schedule, Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule, Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule, Specialized Therapeutic Services Fee Schedule, Speech-Language Pathology Services Fee Schedule, Targeted Case Management for Children at Risk of Abuse and Neglect Services Fee Schedule, Federally Qualified Health Center Billing Codes, Hospital Outpatient Services Billing Codes, Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes, Statewide Inpatient Psychiatric Program Services Billing Codes. 02/05/19. New York State Children’s Health and Behavioral Health Services Billing and Coding Manual . 0360T codes for the procedure used for the first 30 minutes of each day of additional time. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. (Centers for Medicare & Medicaid Services) billing requirements. VERSION 2020-1 September 2020 Page | 6 . These codes will take effect on January 1, 2019. For dates of service on or after January 1, 2019, the 2019 versions of the Current Procedural Terminology (CPT®) and the Healthcare Common Procedure Coding System (HCPCS) medical code sets will be in effect. Please refer to Appendix DD for reimbursement rate of CPT code 36416 (capillary blood draw). Applied Behavior Analysis (ABA) Policy Number: CPCP011 . General . The current codes, H0032 UA for the assessment and H2033 for the service, will remain billable codes on and after January 1, 2019. Behavioral Therapy providers contracted with Magellan of Virginia should continue to use H0032 UA and H2033 on and after January 1, 2019 for reimbursement. 0361T is billed for each additional 30 minutes done on the same day. Twenty-First Edition. Please Note: The rates listed are the Base Medicaid Rates; When the rate is listed as $0, then the claim is either priced manually and requires supporting documentation or prices based as percentage; Codes billed with modifiers may price differently Below are the fee schedules and rates listed by codes for particular provider or facility types. Billing Information. AHCCCS 801 E Jefferson St Phoenix, Az 85034 Find Us On Google Maps. Electronic Billing This link will provide important information and documents for all your electronic billing needs. Beginning July 2019, claims may deny due to common billing issues. February 1, 2017: Applied Behavior Analysis (ABA) services will end and BA services will begin. Please read Quick Tip 221 for additional information. Billing Code Effective Date; County Health Department Billing … Each year Kentucky Medicaid is required to provide an upper payment limit demonstration for CMS on all DME codes covered by Medicaid. These codes should be used on professional claims to specify the entity where service(s) were rendered. New CPT codes for ABA billing have been announced by the American Medical Association CPT Editorial Panel. Version 9.0 Please view the B2B instructions and all Trading Partner information. Policy Number: CPCP011 . Prior Authorization Forms for Specialty Drugs, New Century Health – Oncology Pathway Solutions, NH Community Mental Health Targeted Case Management, Announcing our Annual Provider Satisfaction Survey, Updated Home Health Payment and Clinical Policies, Ambetter FQHC Encounter Code Clarification, NH Healthy Families Sponsors New Initiative for Youth in Foster Care Transition, NH Healthy Families and NH Fisher Cats Team Up with Base Hits for Kids, Supporting Boys & Girls Clubs of NH, New Payment and Clinical Policies Effective October 15, 2018, New Applied Nehavioral Analysis Clinical Policy, NH Healthy Families Summer 2018 Member Newsletter, NH Healthy Families October 2018 Provider Newsletter, NCQA's HEDIS 2019 Volume 2: Technical Specifications for Health Plans, Prohibition of Balance Billing for Ambetter from NH Healthy Families, Change for Therapy Services Beginning March 1, 2019, NH Healthy Families Physical Medicine Prior Authorization Provider Education Webinars, Applied Behavioral Analysis (ABA) Billing Codes - Medicaid, Jaffrey-Rindge Middle School and NH Healthy Families Celebrate National No One Eats Alone Day, New Required Modifier for Habilitative and Rehabilitative Services, NH Healthy Families Pharmacy Policy Update, Physical Medicine Guidelines Effective August 1, 2019, Upcoming Managed Care Organization Contract Changes, NH Healthy Families Partners with North Country Providers to Fund Program Focused on Social Determinants of Health, NH Healthy Families Supports Boys & Girls Clubs of NH with Donation to the Fisher Cats Program Base Hits for Kids, Revised Access Standards Effective September 1, 2019, Transitional Care Management Program Effective September 1, 2019, Upcoming Managed Care Organization Contract Changes Effective September 1, 2019, Medicaid Managed Care Provider Resource Communication, Provider Analytics Tool Scheduled Maintenance, Consultation Services Payment Policy Effective October 1, 2019, Clinical Policies Effective October 1, 2019, Pharmacy Policy Update Effective October 1, 2019, Provider Demographic Data - LexisNexis & American Medical Association Business Solutions, Appointment Availability Standards Survey, NH Healthy Families Earns a 4.5 out of 5 Rating for Quality, Takes Top Spot Among NH Medicaid Health Plans, Changes to Therapy Evaluation Authorization Requirements, NH Healthy Families Addresses Food Insecurity With New Initiative: Green to Go, Pharmacy Policy Update Effective January 1, 2020, Important Notice Regarding Ambetter Provider Payments, Psychiatric Boarding Support Effective March 1, 2020, New Medicare Covered OUD Services Effective January 1, 2020, Creating Connections: A Granite State Integrated Care Symposium, ADDITIONAL STEPS TO PROTECT MEMBERS’ HEALTH AMID COVID-19 OUTBREAK, NH HEALTHY FAMILIES LIVES ITS PURPOSE WITH DIRECT STATEWIDE COVID-19 RELIEF, Alternative Care Sites COVID-19 Preparedness, Creating Connections: A Granite State Integrated Care Symposium *NEW DATE, Pharmacy Policy Update Effective July 1, 2020, MAT (Medication Assisted Treatment) Billing Tip Sheet, SBIRT (Screening, Brief Intervention, and Referral to Treatment) Billing Tip Sheet, NH Department of Health and Human Services (DHHS) Electronic Visit Verification (EVV) Feedback Sessions, Physical Medicine Summary of Changes Effective September 1, 2020, Medicaid Payment for Non-licensed Mental Health and Substance Use Disorder (SUD) Treatment Services, Clinical Practice Guidelines – Children with Special Needs Survey, Coding for Vaccines and Immunizations Reminder, Provider Portal Claim Submittals with EOB Billing Tip Sheet, EXPANDED TELEHEALTH COVERAGE EXTENDED IN RESPONSE TO CONTINUED NATIONAL COVID-19 PUBLIC HEALTH EMERGENCY, Medical Transportation Management [MTM] Effective September 1, 2020, New Musculoskeletal Surgical Quality and Safety Management Program in Partnership with TurningPoint, Pharmacy Policy Update Effective October 1, 2020, Payment & Clinical Policies Effective October 1, 2020, Medical Transportation Management Dedicated Provider Line, Strong Youth, Strong Communities: You Are Not Alone, Payment and Clinical Policies Effective December 1, 2020, Expanded Telehealth Coverage Extended in Response to Continued National COVID-19 Public Health Emergency, Fluvention: When It Comes to the Flu, You call the Shots, Incontinence Supplies and Durable Medical Equipment (DME) Providers, Medicare Advantage Training Webinars for Providers, Updated CAQH & Provider Specialty Profile Enrollment Forms, Important Notice Regarding Provider Payments, Important Notice Regarding Provider Payments-20201217, Written Consent and Care Coordination Best Practices, Pharmacy Policy Update: Effective April 1, 2021, Preventing and Resolving Claim Denials Important Reminders. You will need Adobe Reader to open PDFs on this site. ABA Therapy PA Units Calculation Tip Sheet; Provider Billing Manual -Chapter 105; Administrative Code - Chapter 47; Checklist for Mental Health Providers - Information on denials, reasons for recoupments, where to find information in the Medicaid Provider Billing Manual, free tools and contacts for providers to use in preventing fraud and abuse. UB-04 and NEW CMS 1500 Billing Medicaid Secondary to a Medicare HMO/Advantage Plan: Code can be billed only once every 12 months. 97151 and 91753, 97155, 97156: Concurrent billing is permitted if the BCBA-D, BCBA or assistant behavior analyst is completing an element of the assessment (for example, direct time, report writing) under 97151 and a different BCBA-D, BCBA, assistant behavior analyst, or behavior technician is rendering 97153, 97155 or 97156. Multiple 0361T codes may be needed. Indiana Department of Education . For questions regarding billing requirements, contact a New Hampshire Healthy Families Provider Services Representative at 1-866-769-3085. Listed below are place of service codes and descriptions. If an assessment takes 90 minutes, then two 0361T codes are used.