Learn moreabout how we provide comprehensive support for members. According to Georgia Medicaid guidelines, the insertion of an implantable contraceptive device and the implantable contraceptive reported as part of a Medicaid family planning program is limited to once in a three-year period. The Children's Intervention Services (CIS) Program provides coverage for restorative and rehabilitative services including audiology, health and behavior assessments, nursing services, nutrition services, occupational therapy, orthotic and prosthetic training, physical therapy and speech-language pathology. Resources for Audiologists Medicaid Toolkit: What Audiologists Need to Know endobj %PDF-1.7 The goals of this endeavor will be implemented. If you do not have Adobe Acrobat Reader, you may download ithere. Find clinical tools and information about working with CareSource. The National Drug Code (NDC) is a unique, three-segment number that identifies a drug. Members have full access to the material and can also email us regarding any billing or compliance issue, please considerjoining todayif you need assistance. 3 0 obj \ w|p&buSa!HTNH8zEl&~taFZ>qy|Zu_i-gF7*K_xhM |ykr\5fOy6wAT)+EhK4 9IOfUFJ?!A9Hkz Gv&v>QeIY1.?yL.Tv?{!% Health care claims payment policies are guidelines used to assist in administering payment rules based on generally accepted principles of correct coding. Additionally, monaural hearing aids, when billed, must be reported with modifier RT or LT and are limited to one unit per side in a three-year period. This change is estimated to increase E&D Waiver expenditures for SFY 2022 as follows: The Georgia General Assembly passed legislation to increase Elderly and Disabled Waiver rates by 10% effective July 1, 2021. Under managed care, Georgia pays a fee to a managed care plan for each person enrolled in the plan. 1997- American Speech-Language-Hearing Association. 2 0 obj The Department of Community Heath received approval from the Center of Medicare and Medicaid Services (CMS) for a temporary 5% growth increase effective July 1, 2020 through June 30, 2021 for all nursing home providers. Under the FFS model, Georgia pays providers directly for each covered service received by a Medicaid beneficiary. 322.9. Therapy Comply does not claim copyright over US Federal and State materials. According to Georgia Medicaid guidelines, early and periodic screening, diagnostic and treatment (EPSDT) services should follow the recommended age requirement indicated in the American Academy of Pediatrics (AAP) and Bright Futures 'Recommendations for Pediatric Health Care' periodicity schedule. nursing services, nutrition services, occupational therapy, orthotic and prosthetic training, physical therapy and speech-language pathology. Georgia Medicaid Coverage of Therapy Services. Therefore, when crisis intervention services are billed with modifier U1, U2, U3, U4 or U5 and modifier U6, U7 or GT are not also appended, the crisis intervention services (H2011) will be recommended for denial. They are used to help identify whether health care services are correctly coded for reimbursement. The Initial Reimbursement Rate Sheets for FYE June 30, 2022, are located below. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. It is our intent to make claim payment policies that are simple to understand and in alignment with State Medicaid Manuals. 0 4a, Col 004, lines 002,005,006,008,009,015: 37) Call Us. aJY $,0V #hE2!FF!&`B+4fC&%@ c cTh Clinical policies help identify whether services are medically necessary based on information found in generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by the policy; and other available clinical information. Board of Speech Pathology and Audiology | Georgia Secretary of State (ga.gov) Fee Schedule (*All fees include a $10 mail in application processing fee) *Application for Speech Language Pathologist or Audiologist by Examination, ASHA, or Endorsement $ 120.00 *Application for PCE or RPE $ 40.00 *Application for Speech Aide $ 50.00 hVQo8+zz$[! These services are provided by speech-language-pathologists CPT is a registered trademark of the American Medical Association. Web form outage is expected around 5:30pm on April 28, 2023. They include but are not limited to policies relating to evolving medical technologies and procedures, as well as pharmacy policies. Clinical policies are one set of guidelines used to assist in administering health plan benefits, either by prior authorization or payment rules. After dialing 1-800-273-TALK (1-800-273-8255), the caller is routed to their nearest crisis center to receive immediate counseling and local mental health referrals. Reimbursement policies are designed to assist you when submitting claims to CareSource. . . 04/01/2023. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> According to Georgia Medicaid guidelines, a brief emotional/behavioral assessment performed during a non-periodic screening visit for a patient less than 21 years of age must be reported with modifier EP (EPSDT program) and billed in Place of Service 99 (Other). Guidance on therapy services covered through Georgia Medicaid and other important compliance issues such as enrollment, billing, audits, and managed care. Speech Therapy and Audiology Fee Schedule - Jan. 5, 2022 - PDF. They are used to help identify whether health care services are correctly coded for reimbursement. The Department also received approval for quality incentives related to the Joint Commission and American Health Care Association (AHCA) Accreditation effective August 14, 2020. First Published . American Speech-Language-Hearing Association, Medicaid Toolkit: What Audiologists Need to Know, Federal Public Health Emergency Updates for 2022, Certain Health Care Providers May Be Subject to New COVID Vaccination Requirements, Reimbursement of Telepractice Services: Considerations for Audiologists and SLPs, ASHA's Coding, Reimbursement,& Advocacy Modules, State Children's Health Insurance Program, ASHA Reimbursement Products & Web Seminars, Health Insurance Portability & Accountability Act (HIPAA), Interprofessional Education / Interprofessional Practice, State Advocates for Reimbursement (STARs) Network (one of the. In general, Georgia set provider payments under fee-for-service. Each payment rule is sourced by a generally accepted coding principle. Members also have access to compliance and billing support. Reimbursement rates have been recalculated effective July 1, 2020 through June 30, 2021. The Lifeline supports people who call for themselves or someone they care about. Please enable it in order to use the full functionality of our website. . According to Georgia Medicaid guidelines, the telehealth originating site facility fee must be reported with modifier EP (EPSDT program) and modifier GT (Via interactive audio or video telecommunication systems) when billed in a school setting. SFY 2023 Hospital Provider Fee Memorandum - Posted 06/15/22. All rights reserved. WellCare Health Plans is committed to continuously improving its claims review and payment processes. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Additional information on available services and policy requirements can be obtained by visiting https://dbhdd.georgia.gov/community-provider-manuals. Under managed care, Georgia pays a fee to a managed care plan for each person enrolled in the plan. This area of the Billing and Reimbursement site provides information on the major aspects of Medicaid related to audiology and speech-language pathology services, including audiology and speech-language pathology requirements and information for school based professionals. The three segments identify the labeler, the product, and the commercial package size. You may access the InterQualSmartSheet(s) for Adult and Pediatric procedures, durable medical equipment and imaging procedures by logging into the secure provider portal or by calling Peach State Health Plan. NC Medicaid Contact Center check your deductible, change your Georgia Medicaid offers benefits on a Fee-for-Service (FFS) basis or through managed care plans. Webinar: Medicare Advantage Compliance and Therapy Services, Webinar: Scheduling to Increase Revenue and Reduce Cancellations, Webinar: The Business of Providing PT/OT to Medicare Patients Recorded September 22, 2022, Webinar: Medicare Documentation and Billing Physical and Occupational Therapy September 8, 2022, Webinar: Remote Therapeutic Monitoring July 20, 2022, Webinar: HIPAA Recognized Security Practices, Webinar: Creating a PT/OT Bonus Plan for Your Practice, Webinar: Medicare PT/OT Services and NCCI, Webinar: Defending Your Therapy Practice from Medicare Audits, Webinar: Advising PT/OT Patients about Cannabis: Medical Marijuana and CBD, Webinar: HIPAA Risk Assessments and Mitigation, Webinar: Effective Compliance and Billing Audits for Therapy Practices, Webinar: Financial and Productivity Benchmarking for Outpatient Physical and Hand Therapy, Webinar: Adult Scoliosis Recognition and Physical Therapy Interventions, Webinar: 2022 Billing and Coding Updated for PT/OT, Webinar: CQ-CO Modifiers and Medicare in 2022, Webinar: PT/OT Burnout Resilience & Balance, Webinar: Medicare ABNs and Therapy Services, Webinar: Osteoarthritis Management by Physical Therapists, Webinar: Effective Compliance Plans for Therapy Practices, Webinar: Manual Therapy Principles of the Shoulder, Webinar: HIPAA for Physical and Occupational Therapy, Webinar: Tricare Compliance for PT and OT, Webinar: Documentation of Skilled Therapy, Webinar: Hip Stability and its Effects on Balance and Fall Prevention, Webinar: Managing Conflict Resolution for PTs and OTs, Webinar: Core Stability and its Effects on Balance and Fall Prevention, Webinar: Posture, Aging and Orthopedic Effects on Balance, Webinar: Pills and Spills An Assessment of Medications and Fall Risk in Older Patients, Alabama PT Identification and Notifications, Alabama PT Board Position Statements and Forms, Alabama OT Identification and Notification, Alabama OT Board Position Statements and Forms, Alabama SLP Board Position Statements and Forms, Alabama Covid-19 Resources for Therapy Providers, Alabama Medicaid Coverage of Therapy Services, Alaska Covid-19 Resources for Therapy Providers, Alaska Medicaid Coverage of Therapy Services, Arizona OT Identification and Notifications, Arizona Medicaid Coverage of Therapy Services, Arizona Covid-19 Resources for Therapy Providers, Arkansas Covid-19 Resources for Therapy Providers, Arkansas Medicaid Coverage of Therapy Services, California Covid-19 Resources for Therapy Providers, California Medicaid Coverage of Therapy Services, Colorado Covid-19 Resources for Therapy Providers, Colorado Medicaid Coverage of Therapy Services, Colorado Medicaid Physical and Occupational Therapy, Colorado Medicaid PT and OT Prescription and Referral, Colorado Medicaid PT and OT Documentation Requirements, Colorado Medicaid PT and OT Covered Services, Colorado Medicaid PT and OT Prior Authorization, Connecticut Medicaid Coverage of Therapy Services, Delaware Covid-19 Resources for Therapy Providers, Delaware Medicaid Coverage of Therapy Services, Florida Telehealth Out-of-State Providers, Florida Medicaid Coverage of Therapy Services, Florida Covid-19 Resources For Therapy Providers, Florida PT Board Position Statements and Forms, Florida Occupational Therapy Practice Issues, Florida OT Board Position Statements and Forms, Georgia PT Notifications and Identification, Georgia PT Principles of Conduct for Physical Therapists, Georgia PT Principles of Conduct for Physical Therapy Assistants, Georgia PT Responsibilities and Delegation, Georgia OT Identification and Notification, Georgia Covid-19 Resources for Therapy Providers, Hawaii Covid-19 Resources for Therapy Providers, Hawaii Workers Compensation Fee Schedules, Hawaii Medicaid Coverage of Therapy Services, Idaho Covid-19 Resources for Therapy Providers, Idaho Medicaid Coverage of Therapy Services, Illinois SLP Rigid and Flexible Laryngoscopes, Illinois Covid-19 Resources for Therapy Providers, Illinois Medicaid Coverage of Therapy Services, Illinois Workers Compensation Fee Schedules, Indiana Covid-19 Resources for Therapy Providers, Indiana Medicaid Coverage of Therapy Services, Indiana Workers Compensation Fee Schedules, Iowa Covid-19 Resources for Therapy Providers, Iowa Medicaid Coverage of Therapy Services, Kansas Covid-19 Resources for Therapy Providers, Kansas Medicaid Coverage of Therapy Services, Kansas Workers Compensation Fee Schedules, Kentucky OT Deep Physical Agent Modalities, Kentucky OT Low-Vision and Visual-Therapy Services, Kentucky Covid-19 Resources for Therapy Providers, Kentucky Medicaid Coverage of Therapy Services, Kentucky Workers Compensation Fee Schedules, Louisiana Covid-19 Resources for Therapy Providers, Louisiana Medicaid Coverage of Therapy Services, Louisiana Workers Compensation Fee Schedules, Maine Covid-19 Resources for Therapy Providers, Maine Medicaid Coverage of Therapy Services, Maryland Covid-19 Resources for Therapy Providers, Maryland Medicaid Coverage of Therapy Services, Maryland Workers Compensation Fee Schedules, Massachusetts OT Supervision and Delegation, Massachusetts Covid-19 Resources for Therapy Providers, Massachusetts Medicaid Coverage of Therapy Services, Massachusetts Medicaid Therapy Fee Schedules, Massachusetts Medicaid Outpatient Therapy, Massachusetts Medicaid Provider Enrollment, Massachusetts Workers Compensation Fee Schedules, Michigan Covid-19 Resources for Therapy Providers, Michigan Medicaid Coverage of Therapy Services, Michigan Workers Compensation Fee Schedules, Minnesota Covid-19 Resources for Therapy Providers, Minnesota Medicaid Coverage of Therapy Services, Minnesota Workers Compensation Fee Schedules, Mississippi Covid-19 Resources for Therapy Providers, Mississippi Medicaid Coverage of Therapy Services, Mississippi Medicaid Therapy Fee Schedules, Mississippi Workers Compensation Fee Schedules, Missouri Covid-19 Resources for Therapy Providers, Missouri Medicaid Coverage of Therapy Services, Missouri Workers Compensation Fee Schedules, Montana Covid-19 Resources for Therapy Providers, Montana Medicaid Coverage of Therapy Services, Montana Workers Compensation Fee Schedules, Nebraska Covid-19 Resources for Therapy Providers, Nebraska Medicaid Coverage of Therapy Services, Nebraska Workers Compensation Fee Schedules, Nevada Covid-19 Resources for Therapy Providers, Nevada Medicaid Coverage of Therapy Services, Nevada Workers Compensation Fee Schedules, New Hampshire Covid-19 Resources for Therapy Providers, New Hampshire Medicaid Coverage of Therapy Services, New Hampshire Medicaid Therapy Fee Schedules, New Hampshire Medicaid Outpatient Therapy, New Hampshire Medicaid Provider Enrollment, New Hampshire Workers Compensation Fee Schedules, Use of a Computer to Prepare Patient Records, New Jersey OT Identification and Notification, New Jersey Covid-19 Resources for Therapy Providers, New Jersey Medicaid Coverage of Therapy Services, New Jersey Medicaid Therapy Fee Schedules, New Jersey Workers Compensation Fee Schedules, New Mexico Covid-19 Resources for Therapy Providers, New Mexico Medicaid Coverage of Therapy Services, New Mexico Workers Compensation Fee Schedules, New York Covid-19 Resources for Therapy Providers, New York Medicaid Coverage of Therapy Services, New York Workers Compensation Fee Schedules, North Carolina PT Continuing Education Activities, North Carolina PT General Scope of Practice, North Carolina PT Additional PT Practices, North Carolina PT Additional PTA Practices, North Carolina PT Supervision and Delegation, North Carolina PT Supervision and Documentation, North Carolina PT Identification and Notification, North Carolina PT Licensure by Endorsement, North Carolina OT Identification and Notification, North Carolina Covid-19 Resources for Therapy Providers, North Carolina Medicaid Coverage of Therapy Services, North Carolina Medicaid Outpatient Therapy, North Carolina Medicaid Provider Enrollment, North Carolina Pediatric Therapy Services, North Carolina Workers Compensation Fee Schedules, North Dakota Covid-19 Resources for Therapy Providers, North Dakota Medicaid Coverage of Therapy Services, North Dakota Medicaid Provider Enrollment, North Dakota Workers Compensation Fee Schedules, Ohio OT Temporary License Military Spouse, Ohio Covid-19 Resources for Therapy Providers, Ohio Medicaid Coverage of Therapy Services, Oklahoma PT Board Position Statements and Forms, Oklahoma Covid-19 Resources for Therapy Providers, Oklahoma OT Board Position Statements and Forms, Oklahoma Medicaid Coverage of Therapy Services, Oklahoma Workers Compensation Fee Schedules, Oregon Covid-19 Resources for Therapy Providers, Oregon Medicaid Coverage of Therapy Services, Oregon Workers Compensation Fee Schedules, Pennsylvania PT Transdermal Administration of Drugs, Pennsylvania PT Direct Access Certificates, Pennsylvania PT Supervision and Delegation, Pennsylvania PT Identification and Notification, Pennsylvania Covid-19 Resources for Therapy Resources, Pennsylvania Medicaid Coverage of Therapy Services, Pennsylvania Medicaid Provider Enrollment, Pennsylvania Workers Compensation Fee Schedules, Rhode Island Covid-19 Resources for Therapy Providers, Rhode Island Medicaid Coverage of Therapy Services, Rhode Island Medicaid Provider Enrollment, Rhode Island Workers Compensation Fee Schedules, South Carolina Covid-19 Resources for Therapy Providers, South Carolina Medicaid Coverage of Therapy Services, South Carolina Medicaid Outpatient Therapy, South Carolina Medicaid Provider Enrollment, South Carolina Pediatric Therapy Services, South Carolina Workers Compensation Fee Schedules, South Dakota Covid-19 Resources for Therapy Resources, South Dakota Medicaid Coverage of Therapy Services, South Dakota Medicaid Provider Enrollment, South Dakota Workers Compensation Fee Schedules, Tennessee Covid-19 Resources for Therapy Providers, Tennessee Medicaid Coverage of Therapy Services, Tennessee Workers Compensation Fee Schedules, Texas PT Board Position Statements and Forms, Texas OT Identification and Notifications, Texas Medicaid Coverage of Therapy Services, Texas Medicaid Outpatient Therapy for Children, Texas Medicaid Coverage of PT, OT, and SLP Therapy Service for Adults, Texas Medicaid Therapy Frequency and Duration Criteria, Texas Medicaid Co-Treatment and Group Therapy, Texas Medicaid Definitions for Outpatient Therapy, Texas Covid-19 Resources for Therapy Providers, Utah Covid-19 Resources for Therapy Providers, Utah Medicaid Coverage of Therapy Services, Vermont Covid-19 Resources for Therapy Providers, Vermont Medicaid Coverage of Therapy Services, Vermont Workers Compensation Fee Schedules, Virginia OT Out-of-State Licensee Voluntary Practice, Virginia Covid-19 Resources for Therapy Providers, Virginia Medicaid Coverage of Therapy Services, Virginia Workers Compensation Fee Schedules, Washington OT Identification and Notification, Washington OT Exemption for Short-Term Practice, Washington OT Inactive and Retired Status, Washington Covid-19 Resources for Therapy Providers, Washington Medicaid Coverage of Therapy Services, Washington Medicaid Therapy Fee Schedules, Washington Workers Compensation Fee Schedules, West Virginia Covid-19 Resources for Therapy Providers, West Virginia Medicaid Coverage of Therapy Services, West Virginia Medicaid Therapy Fee Schedules, West Virginia Medicaid Outpatient Therapy, West Virginia Medicaid Provider Enrollment, West Virginia Workers Compensation Fee Schedules, Wisconsin Covid-19 Resources for Therapy Provider, Wisconsin Medicaid Coverage of Therapy Services, Wisconsin Workers Compensation Fee Schedules, Wyoming Physical Therapy Procedures and Modalities, Wyoming Covid-19 Resources for Therapy Providers, Wyoming Medicaid Coverage of Therapy Services, Wyoming Workers Compensation Fee Schedules, Merit-Based Incentive Payment System (MIPS), Measure 126: Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy, Measure 127: Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention, Measure 128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan, Measure 130: Documentation of Current Medications in the Medical Record, Measure 134: Preventive Care and Screening: Screening for Depression and Follow-Up Plan, Measure 181: Elder Maltreatment Screen and Follow-Up Plan, Measure 182: Functional Outcome Assessment, Measure 217: Functional Status Change for Patients with Knee Impairments, Measure 218: Functional Status Change for Patients with Hip Impairments, Measure 219: Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments, Measure 220: Functional Status Change for Patients with Low Back Impairments, Measure 221: Functional Status Change for Patients with Shoulder Impairments, Measure 222: Functional Status Change for Patients with Elbow, Wrist or Hand Impairments, Measure 223: Functional Status Change for Patients with General Orthopedic Impairments, Measure 226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention, Measure 281: Dementia Cognitive Assessment, Measure 282: Dementia: Functional Status Assessment, Measure 288: Dementia: Education and Support of Caregivers for Patients with Dementia, Measure 318: Falls Screening for Future Fall Risk, Measure 478: Functional Status Change for Patients with Neck Impairments, Measure 131: Pain Assessment and Follow-Up, Medicare Enrollment of Occupational Therapists, Medicare Enrollment of Physical Therapists, Medicare Coverage of Specific Modalities and Procedures, National Coverage Determinations for Therapy Services, Medicare Therapy Limitations and Noncovered Services, Medicare Documentation for Therapy Services, Levels of Appeals and Time Limits for Filing, Medicare Therapy Bill Type and Revenue Codes, Medicare Skilled Nursing Facilities Therapy Services, Medicare Home Health Conditions for Coverage, Security Rule - Administrative Safeguards, When Patient Authorization is Not Required, Early Intervention Referrals and Screening, Common Physical and Occupational Therapy Codes, NCCI Medically Unlikely Edits Therapy Services, NCCI Practitioner Edits Therapy Services Q3 2022, NCCI Practitioner Edits Therapy Services Q4 2022, NCCI Practitioner Edits Therapy Services Q1 2023, NCCI Hospital Edits Therapy Services Q3 2022, NCCI Hospital Edits Therapy Services Q4 2022, NCCI Hospital Edits Therapy Services Q1 2023, End of Covid-19 Emergency Period - Medicare Therapy Waivers, Medicare Certification and Recertification Plan of Care FAQs, Multiple Procedure Payment Reduction (MPPR), Medicare Total Time Rule v. AMA 8-Minute Rule, Medicare Documentation Requirements for Therapy Services, Medicare Documentation Requirements for Therapy Practices, New Section: Medicare Therapy Limitations and Noncovered Services, Medicare Telehealth Services During Covid-19 Emergency Period, New Section: Outpatient Rehabilitation Facilities.
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