Procedures for Billing and Reimbursement for EIS Providers Sample Clauses

Procedures for Billing and Reimbursement for EIS Providers. A procedure code table for Early Intervention Services is listed in Attachment 2 of this document. The fee schedules for IDEA/Part C services can be found at xxxxx://xxxxxx.xxx/resource/fee-schedules. Please note that only the codes listed on the table in Attachment 2 are reimbursable. Additional procedure codes on the fee schedules, but not listed in the code table, are not reimbursable. APPENDIX A: ATTACHMENTS Attachment 1: BabyNet Provider Enrollment Packet Checklist ✓ BabyNet Provider Enrollment Packet Checklist BabyNet Provider Enrollment Form BabyNet Individual User Confidentiality Agreement BabyNet Drug-Free Workplace Statement An IRS W-9 form The enrolling provider’s NPI number, or if the enrolling provider is a licensed therapy assistant, the NPI of the supervising provider Provider’s Legacy ID/Number All relevant taxonomy codes A copy of the current licensure Proof of current liability insurance A national background check that includes: Nationwide Office of Inspector General Background Check (current within 365 days of the enrollment packet) Nationwide Sex Offender Registry Background Check (current within 365 days of the enrollment packet) Nationwide Criminal Report Background Check (current within 365 days of the enrollment packet) SSN Verification Residency History Check Professional License Verification Attachment 2: Approved Procedure Codes for Early Intervention Services SERVICE LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier BN Service Limit Count Pay Per BN Service Limit Frequency Audiology Evaluation and Services 92557 - Audiological Consultation U1 6 Encounter Per Year 92557 - Hearing Evaluation U2 6 Encounter Per Year 92587 - Evoked Otoacoustic Emissions; (Evaluation) 6 Encounter Per Year 92588 - Evoked Otoacoustic Emissions; (Screening) 12 Encounter Per Year 92620 - Auditory Evaluation with Report (60 Min.) 1 Encounter Per Encounter 92625 - Assessment of Tinnitus (Includes Pitch, Loudness Matching, And Masking) 1 Encounter Per Encounter 92626 - Evaluation Auditory Rehab Status 1St Hr. 10 Encounter Per Year V5020 - Conformity Evaluation 1 Encounter Per Encounter 92594 - Electroacoustic Eval Hearing Aid Monaural 6 Encounter Per Year 92595 - Electroacoustic Eval Hearing Aid Binaural 6 Encounter Per Year 92557 - Hearing Re-Evaluation 6 Encounter Per Year 92568 - Acoustic Reflex Testing; Threshold 1 Encounter Per Encounter 92550 - Tympanometry and Reflex Threshold Measurements 1 Encounter Per Encounter 92551 - Screeni...
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