Service Coordinator Responsibilities in Service Provision. The Service Coordinator authorizes all services to be reimbursed by IDEA/Part C by placing them on the Individualized Family Service Plan (IFSP) in BRIDGES as follows: • If the family does not have Medicaid coverage, parental consent to use private insurance is required to cover the cost of early intervention services and must be documented by service on the planned services screen in BRIDGES. It is the responsibility of the Service Coordinator to input the correct consent status. It may be necessary for the Service Coordinator to contact the insurance company to verify carrier codes and coverage. Please see Appendix C for additional guidance on this payor source. • Parental consent to use Medicaid is not required. • Services must be documented in the “Planned Services” section of the IFSP and prior authorization received (if required) before IFSP services can be initiated by the EIS provider. If the child is enrolled in one of SCDHHS’ Managed Care Organizations (MCO), the Service Coordinator must send a hardcopy of the IFSP and the MCO Universal BabyNet Prior Authorization (PA) form to the MCO for the PA process to proceed . Service Coordinators must correctly enter the following for each planned service: • Type of early intervention service • Name of EIS provider. • Name of licensed professional providing supervision to licensed therapy assistants. • The name of the individual providing supervision for service coordination can be entered for coverage of service coordination during staff absences or so they can access the record following staff resignation or termination. The Service Coordinator should follow their company/agency procedures in adding their supervisor as a separate line of service coordination in Planned Services. • Location in which service will be delivered. • How long (duration) the provider will work with the family and child (e.g., number of minutes per service event). • How often (frequency) the provider will work with the family and child (e.g., weekly, monthly, quarterly, twice a year). • The start date and end date the service is authorized for. All services must be reviewed and if appropriate reauthorized every six months through periodic review of the IFSP. In coordination with the SCDHHS Medicaid system, BRIDGES will ensure that IDEA/Part C service funds are used as payor of last resort. See procedures for System of Payments for documentation of parent consent to use private insurance. IFSP meetings must also be listed on the “Planned Services” section of the IFSP for each EIS Provider listed on the plan. EIS Provider Responsibilities in Service Provision: All EIS providers are responsible for making sure they review the IFSP in BRIDGES prior to rendering the service to ensure that information shown on the “Planned Services” screen is correct. Service events occurring outside the start date or end date will not be reimbursed. Following each service event, the EIS provider is responsible for entering a service log in BRIDGES within 7 calendar days. If the service was provided by a licensed therapy assistant, both Planned Services and service logs must reflect the supervision of the assistant at the frequency required by the South Carolina Department of Labor, Licensing, and Regulations (SCLLR). Procedures for Billing and Reimbursement for EIS Providers The fee schedules for IDEA/Part C services will match SCDHHS services, and can be found at xxxxx://xxxxxx.xxx/resource/fee-schedules. Steps for submission of claims and billing are included in APPENDIX C of this document. Appendix A: 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 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 Appendix B: Federal Definitions of Early Intervention Services SERVICE DESCRIPTION: ASSISTIVE TECHNOLOGY – 34 CFR §303.13(B)(1) Assistive technology device means any item, piece of equipment or product system, whether acquired commercially off the shelf or modified or customized, that is used to increase, maintain, or improve the developmental capabilities of children with disabilities. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization (e.g., mapping), maintenance, or replacement of the device. Part C of IDEA deals only with assistive technology that is directly relevant to the developmental needs of the child. Assistive technology devices must assist the child in accomplishing functional IFSP goals/objectives within their everyday activities and routines. IDEA specifically excludes services that are surgical in nature and devices necessary to control or treat a medical condition. Equipment/Devices must be developmentally appropriate to be considered eligible for funding. Assistive technology service means a service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device. Assistive technology services include: • The evaluation of needs of an infant or toddler with a disability or developmental delay, including a functional evaluation of the child in the child’s natural/customary environment; • Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities or developmental delays; • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; • Coordinator and using other therapies, interventions, or services with assistive technology devices such as those associated with existing education and rehabilitation plans and programs; • Training or technical assistance for a child with developmental delays and that child’s family or caregiver; • Training or technical assistance for professional (including individuals providing IDEA/PART C Services) or other individuals who provide services to or are otherwise substantially involved in the major life functions of children with disabilities. All approved assistive technology devices will be reimbursed at the Medicaid DME reimbursement rate. Approved items not covered by Medicaid will be reimbursed at the manufactures suggested retail price. SERVICE DESCRIPTION: AUDIOLOGY – 34 CFR §303.13(B)(2) Audiology services include: • Identification of children with auditory impairment using appropriate audiological screening. • Determination of the range, nature, and degree of hearing loss and communication functions by use of audiological evaluation procedures. • Referral for medical and other services necessary for the habilitation and rehabilitation of children with hearing loss; • Attending IFSP meetings. • Provision of auditory training, aural rehabilitation, speech reading and listening device orientation/training, and other related services. • Provision of services for prevention of hearing loss. • Determination of the child’s need for individual amplification including selecting, fitting, and dispensing appropriate listening and vibrotactile devices. • Evaluating the effectiveness of assistive technology devices.
Appears in 2 contracts
Samples: Autism Services, msp.scdhhs.gov
Service Coordinator Responsibilities in Service Provision. The Service Coordinator authorizes all services to be reimbursed by IDEA/Part C by placing them on the Individualized Family Service Plan (IFSP) in BRIDGES as follows: • If the family does not have Medicaid coverage, parental consent to use private insurance is required to cover the cost of early intervention services and must be documented by service on the planned services screen in BRIDGES. It is the responsibility of the Service Coordinator to input the correct consent status. It may be necessary for the Service Coordinator to contact the insurance company to verify carrier codes and coverage. Please see Attachment 3 of this Appendix C for additional guidance on this payor source. • Parental consent to use Medicaid is not required. • Services must be documented in the “Planned Services” section of the IFSP and prior authorization received (if required) before IFSP services can be initiated by the EIS provider. If the child is enrolled in one of SCDHHS’ Managed Care Organizations (MCO), the Service Coordinator must send a hardcopy of the IFSP and the MCO Universal BabyNet Prior Authorization (PA) form to the MCO for the PA process to proceed . Service Coordinators must correctly enter the following for each planned service: • Type of early intervention service • Name of EIS provider. • Name of licensed professional providing supervision to licensed therapy assistants. • The name of the individual providing supervision for service coordination can be entered for coverage of service coordination during staff absences or so they can access the record following staff resignation or termination. The Service Coordinator should follow their company/agency procedures in adding their supervisor as a separate line of service coordination in Planned Services. • Location in which service will be delivered. • How long (duration) the provider will work with the family and child (e.g., number of minutes per service event). • How often (frequency) the provider will work with the family and child (e.g., weekly, monthly, quarterly, twice a year). • The start date and end date the service is authorized for. All services must be reviewed and if appropriate reauthorized every six months through periodic review of the IFSP. In coordination with the SCDHHS Medicaid system, BRIDGES will ensure that IDEA/Part C service funds are used as payor of last resort. See procedures for System of Payments for documentation of parent consent to use private insurance. IFSP meetings must also be listed on the “Planned Services” section of the IFSP for each EIS Provider listed on the plan. EIS Provider Responsibilities in Service Provision: All EIS providers are responsible for making sure they review the IFSP in BRIDGES prior to rendering the service to ensure that information shown on the “Planned Services” screen is correct. Service events occurring outside the start date or end date will not be reimbursed. Following each service event, the EIS provider is responsible for entering a service log in BRIDGES within 7 calendar days. If the service was provided by a licensed therapy assistant, both Planned Services and service logs must reflect the supervision of the assistant at the frequency required by the South Carolina Department of Labor, Licensing, and Regulations (SCLLR). 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 will match SCDHHS services, and can be found at xxxxx://xxxxxx.xxx/resource/fee-schedules. Please note that only the codes listed on the table in Appendix A are reimbursable. Additional procedure codes on the fee schedules, but not listed in the code table, are not reimbursable. Steps for submission of claims and billing are included in APPENDIX C Attachment 3 of this documentAppendix. Appendix AAttachment 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 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 Appendix BAttachment 2: Federal Definitions of Approved Procedure Codes for Early Intervention Services SERVICE DESCRIPTIONLOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency AUDIOLOGY EVALUATION and SERVICES 92557 - Audiological Consultation U1 Encounter 6 Per Year 92557 - Hearing Evaluation U2 Encounter 6 Per Year 92587 - Evoked Otoacoustic Emissions; (Evaluation) Encounter 6 Per Year 92588 - Evoked Otoacoustic Emissions; (Screening) Encounter 12 Per Year 92620 - Auditory Evaluation with Report (60 Min.) Encounter 1 Per Encounter 92625 - Assessment of Tinnitus (Includes Pitch, Loudness Matching, And Masking) Encounter 1 Per Encounter 92626 - Evaluation Auditory Rehab Status 1St Hr. Encounter 10 Per Year V5020 - Conformity Evaluation Encounter 1 Per Encounter 92594 - Electroacoustic Eval Hearing Aid Monaural Encounter 6 Per Year 92595 - Electroacoustic Eval Hearing Aid Binaural Encounter 6 Per Year 92557 - Hearing Re-Evaluation Encounter 6 Per Year 92568 - Acoustic Reflex Testing; Threshold Encounter 1 Per Encounter 92550 - Tympanometry and Reflex Threshold Measurements Encounter 1 Per Encounter 92551 - Screening Test, Pure Tone, Air Only Encounter 1 Per Encounter 92552 - Pure Tone Audiometry Air Only Encounter 6 Per Year 92553 - Pure Tone Audiometry Air & Bone Encounter 1 Per Encounter 92555 - Speech Audiometry Threshold Encounter 1 Per Encounter 92556 - Speech Audiometry Threshold Speech Recognition Encounter 1 Per Encounter 92563 - Tone Decay Test Encounter 1 Per Encounter 92567 - Tympanometry Encounter 6 Per Year 92570 - Tympanogram and Acoustic Reflexes Encounter 6 Per Year 92579 - Visual Reinforcement Audiometry Encounter 1 Per Encounter 92582 - Conditioning Play Audiometry Encounter 1 Per Encounter 92583 - Select Picture Audiometry Encounter 1 Per Encounter 92584 - Electrocochleography Encounter 1 Per Encounter 92586 - Auditory Evoked Potentials for Evoked Response / Audiometry Nerve Encounter 1 Per Encounter 92585 - Auditory Evoked Potentials for Evoked Response (Diagnostic) Encounter 1 Per Encounter 92590 - Hearing Aid Examination & Selection Monaural Encounter 6 Per Year 92591 - Hearing Aid Examination & Selection Binaural Encounter 6 Per Year 92592 - Hearing Aid Check Monaural Encounter 6 Per Year 92593 - Hearing Aid Check Binaural Encounter 6 Per Year V5275 - Ear Impression* Encounter 3 Per Year V5011 - Fitting/Orientation/Checking Hearing Aid Encounter 1 Per Encounter V5264 - Ear Mold/Insert, Not Disposable, Any Type Encounter 1 Per Encounter V5090 - Dispensing Fee, Unspecified Hearing Aid Encounter 1 Per Encounter *If billing V5275, enter one unit if billing for only one ear impression, no modifier. Enter 2 units if billing for 2 impressions, no modifier. Number of units is limited 6/year. AUTISM EVALUATION 97151 - Behavior Identification Assessment Units 32 Lifetime AUTISM SERVICES 97153 - Adaptive Behavior Treatment Units 160 Week 97155 - Adaptive Behavior Treatment with Protocol Modification Units 64 Month 97156 - Family Adaptive Behavior Treatment Guidance Units 48 Year PSYCHOLOGICAL EVALUATION 96101 - Psychological Testing and Evaluation (Per Hour) Units 40 Lifetime 90791 - Psychiatric Diagnostic Evaluation Encounter 40 Lifetime 96130/96131 - Psychological testing and evaluation (1st 60 min/ Additional 60 min) Units 40 Lifetime 96136/96137 - Psychological testing (administration and scoring) (1st 30 min/ Additional 30 min) Units 40 Lifetime 96138/96139 - Psychological testing by technician (1st 30 min/ Additional 30 min) Units 40 Lifetime 96146 - Psychological testing (single standardized) Units 40 Lifetime 96112/96113 - Developmental testing (motor and language) (1st 60 min/ Additional 30 min) Units 40 Lifetime COUNSELING AND PSYCHOLOGICAL SERVICES 9940X - Prevent Med Counsel&/Risk Factor Encounter 1 Per Day MEDICAL EVALUATION 99381 - Initial Health Evaluation (Age 0 to 1 Year) Encounter 1 Lifetime 99382 - Initial Health Evaluation (Age 1+) Encounter 1 Lifetime 99391 - Health Evaluation (Age 0 to 1 year) Encounter 1 Per Year 99392 - Health Evaluation (Age 1+) Encounter 1 Per Year NURSING EVALUATION T1001 - Nursing Assessment/Evaluation Encounter 48 Per Year NURSING SERVICES T1002 - RN Services, Up To 15 Minutes Units 64 Per Month T1003 - LPN/LVN Services, Up To 15 Minutes Units 64 Per Month NUTRITION EVALUATION 97802 - Nutrition Assessment and Intervention; Initial Assessment Units 12 Per Year SERVICE LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency 97803 - Medical Nutrition Therapy; Re-Assessment and Intervention, Individual, Face-To-Face With T Units 12 Per Year NUTRITION SERVICES S9470 - Nutritional Counseling, Dietitian Visit Units 64 Per Month OCCUPATIONAL THERAPY EVALUATION 9716Y - Occupational Therapy Evaluation Encounter 2 Per Year 97168 - Occupational Therapy Re-evaluation Encounter 2 Per Year OCCUPATIONAL THERAPY SERVICES 97530 - Occupational Therapy Services (15 min.) GO Units 4 Per Day PHYSICAL THERAPY EVALUATION 9716X - Physical Therapy Evaluation Encounter 2 Per Year 97164 - Physical Therapy Re-evaluation (20 min.) Encounter 2 Per Year PHYSICAL THERAPY SERVICES 97110 - Physical Therapy Services (15 min. exercises) GP Units 4 Per Day 97530 - Physical Therapy Services (15 min. exercises) GP Units 4 Per Day SOCIAL WORK SERVICES 9083X - Psychotherapy Encounter 8 Per Week SPEECH-LANGUAGE EVALUATION/RE-EVALUATION 92521 - Speech Evaluation (fluency) Encounter 1 Lifetime 92522 - Speech Evaluation (sound production) Encounter 1 Lifetime 92523 - Speech Evaluation (language comprehension) Encounter 1 Lifetime 92524 - Speech Evaluation (voice and resonance) Encounter 1 Lifetime 92610 - Speech Evaluation (oral/pharyngeal wall) Encounter 1 Lifetime S9152 - Speech Therapy Re-evaluation Encounter 2 Per Year SPEECH-LANGUAGE PATHOLOGY SERVICES 92507 - Speech Therapy (voice command/auditory proc) Units 4 Per Day 92526 - Speech Therapy (swallowing/feeding) Units 4 Per Day 92609 - Speech Therapy (use of device) Encounter 1 Per Day VISION EVALUATION AND SERVICES 92002 -Vision Evaluation (new patient intermediate) Encounter 1 Lifetime 92004 - Vision Evaluation (new patient comprehensive) Encounter 1 Lifetime 92012 - Vision Evaluation (established patient intermediate) Encounter 1 Per Year 92014 - Vision Evaluation (established patient comprehensive) Encounter 1 Per Year 92015 - Vision Evaluation Add-On - Refraction Test Encounter 1 Per Year SCSDB EVALUATION AND SERVICES Interpretation: Deaf and Hard of Hearing Units 8 Per Day Cued Language Units 4 Per Day T1024 - Orientation and Mobility Evaluation U3 Units 8 Lifetime T1024 - Orientation and Mobility Instruction U2 Units 30 Per Week IFSP MEETING-SERVICE COORDINATION T1018 - Family Training IFSP Meeting TL Units 8 Per Day IFSP MEETING-SERVICE PROVIDERS (ALL) T1024 - IFSP Team Meeting/Participation (Team Members) Units 8 Per Day SERVICE COORDINATION T1016 - Service Coordination TL Units 16 Per Day FAMILY TRAINING, COUNSELING, AND HOME VISITS (SPECIAL INSTRUCTION SERVICES) T1027 - Family Training & Counseling (15 Min.) TL Units 4 Per Day FOREIGN LANGUAGE SERVICES FLT00- Foreign Language Translation Units 6 Per IFSP FLI00- Foreign Language Interpretation Units 12 Daily TRANSPORTATION AND RELATED COSTS TT000- Transportation-Taxi Miles No limit No limit TFA00- Transportation-Family Auto Miles No limit No limit TO000- Transportation-Other Miles No limit No limit ASSISTIVE TECHNOLOGY – 34 CFR §303.13(B)(1) TECHOLOGY SERVICES AND DEVICES ATDAS- Assistive technology device means any item, piece of equipment or product system, whether acquired commercially off the shelf or modified or customized, that is used to increase, maintain, or improve the developmental capabilities of children with disabilities. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization (e.g., mapping), maintenance, or replacement of the device. Technology Services and Devices Units As Approved As Approved Step Submitting Claims for IDEA/Part C of IDEA deals only Early Intervention Services 1 Provider confirms with Service Coordinator that service payor is correct in BRIDGES. NOTE: IDEA/Part C must always be Payor 1 for all assistive technology that is directly relevant to the developmental needs of the child. Assistive technology devices must assist the child in accomplishing functional IFSP goals/objectives within their everyday activities services and routines. IDEA specifically excludes services that are surgical in nature and devices necessary to control or treat a medical condition. Equipment/Devices must be developmentally appropriate to be considered eligible for funding. Assistive technology service means a service that directly assists a child with a disability in the selectiondevices, acquisitionforeign language interpretation, or use of an assistive technology device. Assistive technology services include: • The evaluation of needs of an infant or toddler with a disability or developmental delayforeign language translation, including a functional evaluation of the child in the child’s natural/customary environment; • Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities or developmental delays; • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; • Coordinator and using other therapies, interventions, or services with assistive technology devices such as those associated with existing education and rehabilitation plans and programs; • Training or technical assistance for a child with developmental delays and that child’s family or caregiver; • Training or technical assistance for professional (including individuals providing IDEA/PART C Services) or other individuals who provide services to or are otherwise substantially involved in the major life functions of children with disabilities. All approved assistive technology devices will be reimbursed at the Medicaid DME reimbursement rate. Approved items not covered by Medicaid will be reimbursed at the manufactures suggested retail price. SERVICE DESCRIPTION: AUDIOLOGY – 34 CFR §303.13(B)(2) Audiology services include: • Identification of children with auditory impairment using appropriate audiological screening. • Determination of the range, naturetransportation, and degree of hearing loss and communication functions by use of audiological evaluation procedures. • Referral for medical and other services necessary for the habilitation and rehabilitation of children with hearing loss; • Attending IFSP meetings. • Provision of auditory training, aural rehabilitation, speech reading and listening device orientation/training, and other related compensatory services. • Provision NOTE: Private Insurance will never be Payor 1 for service coordinator or special instruction services. 2 Provider secures Prior Authorization from payor source before initiation of services for prevention of hearing loss(see table below). • Determination of the child’s need for individual amplification including selecting, fitting, 3 Provider delivers services as documented in IFSP. 4 Provider enters service log in BRIDGES and dispensing appropriate listening and vibrotactile devices. • Evaluating the effectiveness of assistive technology devicesclicks ‘Save.’ 5 The saved service log is captured as BRIDGES Accounts Payable journal entry.
Appears in 1 contract
Samples: msp.scdhhs.gov
Service Coordinator Responsibilities in Service Provision. The Service Coordinator authorizes all services to be reimbursed by IDEA/Part C by placing them on the Individualized Family Service Plan (IFSP) in BRIDGES as follows: • If the family does not have Medicaid coverage, parental consent to use private insurance is required to cover the cost of early intervention services and must be documented by service on the planned services screen in BRIDGES. It is the responsibility of the Service Coordinator to input the correct consent status. It may be necessary for the Service Coordinator to contact the insurance company to verify carrier codes and coverage. Please see Appendix C for additional guidance on this payor source. • Parental consent to use Medicaid is not required. • Services must be documented in the “Planned Services” section of the IFSP and prior authorization received (if required) before IFSP services can be initiated by the EIS provider. If the child is enrolled in one of SCDHHS’ Managed Care Organizations (MCO), the Service Coordinator must send a hardcopy of the IFSP and the MCO Universal BabyNet Prior Authorization (PA) form to the MCO for the PA process to proceed . Service Coordinators must correctly enter the following for each planned service: • Type of early intervention service • Name of EIS provider. • Name of licensed professional providing supervision to licensed therapy assistants. • The name of the individual providing supervision for service coordination can be entered for coverage of service coordination during staff absences or so they can access the record following staff resignation or termination. The Service Coordinator should follow their company/agency procedures in adding their supervisor as a separate line of service coordination in Planned Services. • Location in which service will be delivered. • How long (duration) the provider will work with the family and child (e.g., number of minutes per service event). • How often (frequency) the provider will work with the family and child (e.g., weekly, monthly, quarterly, twice a year). • The start date and end date the service is authorized for. All services must be reviewed and if appropriate reauthorized every six months through periodic review of the IFSP. In coordination with the SCDHHS Medicaid system, BRIDGES will ensure that IDEA/Part C service funds are used as payor of last resort. See procedures for System of Payments for documentation of parent consent to use private insurance. IFSP meetings must also be listed on the “Planned Services” section of the IFSP for each EIS Provider listed on the plan. EIS Provider Responsibilities in Service Provision: All EIS providers are responsible for making sure they review the IFSP in BRIDGES prior to rendering the service to ensure that information shown on the “Planned Services” screen is correct. Service events occurring outside the start date or end date will not be reimbursed. Following each service event, the EIS provider is responsible for entering a service log in BRIDGES within 7 calendar days. If the service was provided by a licensed therapy assistant, both Planned Services and service logs must reflect the supervision of the assistant at the frequency required by the South Carolina Department of Labor, Licensing, and Regulations (SCLLR). Procedures for Billing and Reimbursement for EIS Providers The fee schedules for IDEA/Part C services will match SCDHHS services, and can be found at xxxxx://xxxxxx.xxx/resource/fee-schedules. Steps for submission of claims and billing are included in APPENDIX C of this document. Appendix A: 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 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 Appendix B: Federal Definitions of Approved Procedure Codes for Early Intervention Services SERVICE DESCRIPTION: ASSISTIVE TECHNOLOGY – 34 CFR §303.13(B)(1LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency AUDIOLOGY EVALUATION and SERVICES 92557 - Audiological Consultation U1 Encounter 6 Per Year 92557 - Hearing Evaluation U2 Encounter 6 Per Year 92587 - Evoked Otoacoustic Emissions; (Evaluation) Assistive technology device means any itemEncounter 6 Per Year 92588 - Evoked Otoacoustic Emissions; (Screening) Encounter 12 Per Year 92620 - Auditory Evaluation with Report (60 Min.) Encounter 1 Per Encounter 92625 - Assessment of Tinnitus (Includes Pitch, piece of equipment or product systemLoudness Matching, whether acquired commercially off the shelf or modified or customizedAnd Masking) Encounter 1 Per Encounter 92626 - Evaluation Auditory Rehab Status 1St Hr. Encounter 10 Per Year V5020 - Conformity Evaluation Encounter 1 Per Encounter 92594 - Electroacoustic Eval Hearing Aid Monaural Encounter 6 Per Year 92595 - Electroacoustic Eval Hearing Aid Binaural Encounter 6 Per Year 92557 - Hearing Re-Evaluation Encounter 6 Per Year 92568 - Acoustic Reflex Testing; Threshold Encounter 1 Per Encounter 92550 - Tympanometry and Reflex Threshold Measurements Encounter 1 Per Encounter 92551 - Screening Test, that is used Pure Tone, Air Only Encounter 1 Per Encounter 92552 - Pure Tone Audiometry Air Only Encounter 6 Per Year 92553 - Pure Tone Audiometry Air & Bone Encounter 1 Per Encounter 92555 - Speech Audiometry Threshold Encounter 1 Per Encounter 92556 - Speech Audiometry Threshold Speech Recognition Encounter 1 Per Encounter 92563 - Tone Decay Test Encounter 1 Per Encounter 92567 - Tympanometry Encounter 6 Per Year 92570 - Tympanogram and Acoustic Reflexes Encounter 6 Per Year 92579 - Visual Reinforcement Audiometry Encounter 1 Per Encounter 92582 - Conditioning Play Audiometry Encounter 1 Per Encounter 92583 - Select Picture Audiometry Encounter 1 Per Encounter 92584 - Electrocochleography Encounter 1 Per Encounter 92586 - Auditory Evoked Potentials for Evoked Response / Audiometry Nerve Encounter 1 Per Encounter 92585 - Auditory Evoked Potentials for Evoked Response (Diagnostic) Encounter 1 Per Encounter 92590 - Hearing Aid Examination & Selection Monaural Encounter 6 Per Year 92591 - Hearing Aid Examination & Selection Binaural Encounter 6 Per Year 92592 - Hearing Aid Check Monaural Encounter 6 Per Year 92593 - Hearing Aid Check Binaural Encounter 6 Per Year V5275 - Ear Impression, Left LT Encounter 3 Per Year V5275 - Ear Impression, Right RT Encounter 3 Per Year V5011 - Fitting/Orientation/Checking Hearing Aid Encounter 1 Per Encounter V5264 - Ear Mold/Insert, Not Disposable, Any Type Encounter 1 Per Encounter V5090 - Dispensing Fee, Unspecified Hearing Aid Encounter 1 Per Encounter AUTISM EVALUATION 97151 - Behavior Identification Assessment Units 32 Lifetime AUTISM SERVICES 97153 - Adaptive Behavior Treatment Units 160 Week 97155 - Adaptive Behavior Treatment with Protocol Modification Units 64 Month 97156 - Family Adaptive Behavior Treatment Guidance Units 48 Year PSYCHOLOGICAL EVALUATION 96101 - Psychological Testing and Evaluation (Per Hour) Units 40 Lifetime 90791 - Psychiatric Diagnostic Evaluation Encounter 40 Lifetime 96130/96131 - Psychological testing and evaluation (1st 60 min/ Additional 60 min) Units 40 Lifetime 96136/96137 - Psychological testing (administration and scoring) (1st 30 min/ Additional 30 min) Units 40 Lifetime 96138/96139 - Psychological testing by technician (1st 30 min/ Additional 30 min) Units 40 Lifetime 96146 - Psychological testing (single standardized) Units 40 Lifetime 96112/96113 - Developmental testing (motor and language) (1st 60 min/ Additional 30 min) Units 40 Lifetime COUNSELING AND PSYCHOLOGICAL SERVICES 9940X - Prevent Med Counsel&/Risk Factor Encounter 1 Per Day MEDICAL EVALUATION 99381 - Initial Health Evaluation (Age 0 to increase1 Year) Encounter 1 Lifetime 99382 - Initial Health Evaluation (Age 1+) Encounter 1 Lifetime 99391 - Health Evaluation (Age 0 to 1 year) Encounter 1 Per Year 99392 - Health Evaluation (Age 1+) Encounter 1 Per Year SERVICE LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency NURSING EVALUATION T1001 - Nursing Assessment/Evaluation Encounter 48 Per Year NURSING SERVICES T1002 - RN Services, maintainUp To 15 Minutes Units 64 Per Month T1003 - LPN/LVN Services, or improve the developmental capabilities of children with disabilitiesUp To 15 Minutes Units 64 Per Month NUTRITION EVALUATION 97802 - Nutrition Assessment and Intervention; Initial Assessment Units 12 Per Year 97803 - Medical Nutrition Therapy; Re-Assessment and Intervention, Individual, Face-To- Face With T Units 12 Per Year NUTRITION SERVICES S9470 - Nutritional Counseling, Dietitian Visit Units 64 Per Month OCCUPATIONAL THERAPY EVALUATION 9716Y - Occupational Therapy Evaluation Encounter 2 Per Year 97168 - Occupational Therapy Re-evaluation Encounter 2 Per Year OCCUPATIONAL THERAPY SERVICES 97530 - Occupational Therapy Services (15 min.) GO Units 4 Per Day PHYSICAL THERAPY EVALUATION 9716X - Physical Therapy Evaluation Encounter 2 Per Year 97164 - Physical Therapy Re-evaluation (20 min.) Encounter 2 Per Year PHYSICAL THERAPY SERVICES 97110 - Physical Therapy Services (15 min. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization exercises) GP Units 4 Per Day 97530 - Physical Therapy Services (e.g., mapping), maintenance, or replacement of the device15 min. Part C of IDEA deals only with assistive technology that is directly relevant to the developmental needs of the child. Assistive technology devices must assist the child in accomplishing functional IFSP goalsexercises) GP Units 4 Per Day SOCIAL WORK SERVICES 9083X - Psychotherapy Encounter 8 Per Week SPEECH-LANGUAGE EVALUATION/objectives within their everyday activities RE-EVALUATION 92521 - Speech Evaluation (fluency) Encounter 1 Lifetime 92522 - Speech Evaluation (sound production) Encounter 1 Lifetime 92523 - Speech Evaluation (language comprehension) Encounter 1 Lifetime 92524 - Speech Evaluation (voice and routines. IDEA specifically excludes services that are surgical in nature and devices necessary to control or treat a medical condition. Equipmentresonance) Encounter 1 Lifetime 92610 - Speech Evaluation (oral/Devices must be developmentally appropriate to be considered eligible for funding. Assistive technology service means a service that directly assists a child with a disability in the selection, acquisition, or pharyngeal wall) Encounter 1 Lifetime S9152 - Speech Therapy Re-evaluation Encounter 2 Per Year SPEECH-LANGUAGE PATHOLOGY SERVICES 92507 - Speech Therapy (voice command/auditory proc) Units 4 Per Day 92526 - Speech Therapy (swallowing/feeding) Units 4 Per Day 92609 - Speech Therapy (use of an assistive technology device. Assistive technology services include: • The evaluation of needs of an infant or toddler with a disability or developmental delay, including a functional evaluation of the child in the child’s natural/customary environment; • Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities or developmental delays; • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; • Coordinator and using other therapies, interventions, or services with assistive technology devices such as those associated with existing education and rehabilitation plans and programs; • Training or technical assistance for a child with developmental delays and that child’s family or caregiver; • Training or technical assistance for professional ) Encounter 1 Per Day VISION EVALUATION AND SERVICES 92002 -Vision Evaluation (including individuals providing IDEA/PART C Servicesnew patient intermediate) or other individuals who provide services to or are otherwise substantially involved in the major life functions of children with disabilities. All approved assistive technology devices will be reimbursed at the Medicaid DME reimbursement rate. Approved items not covered by Medicaid will be reimbursed at the manufactures suggested retail price. SERVICE DESCRIPTION: AUDIOLOGY – 34 CFR §303.13(B)(2Encounter 1 Lifetime 92004 - Vision Evaluation (new patient comprehensive) Audiology services include: • Identification of children with auditory impairment using appropriate audiological screening. • Determination of the range, nature, and degree of hearing loss and communication functions by use of audiological evaluation procedures. • Referral for medical and other services necessary for the habilitation and rehabilitation of children with hearing loss; • Attending IFSP meetings. • Provision of auditory training, aural rehabilitation, speech reading and listening device orientation/training, and other related services. • Provision of services for prevention of hearing loss. • Determination of the child’s need for individual amplification including selecting, fitting, and dispensing appropriate listening and vibrotactile devices. • Evaluating the effectiveness of assistive technology devices.Encounter 1 Lifetime 92012 - Vision Evaluation (established patient intermediate) Encounter 1 Per Year 92014 - Vision Evaluation (established patient comprehensive) Encounter 1 Per Year 92015 - Vision Evaluation Add-On - Refraction Test Encounter 1 Per Year SCSDB EVALUATION AND SERVICES
Appears in 1 contract
Samples: Autism Services
Service Coordinator Responsibilities in Service Provision. The Service Coordinator authorizes all services to be reimbursed by IDEA/Part C by placing them on the Individualized Family Service Plan (IFSP) in BRIDGES as follows: • If the family does not have Medicaid coverage, parental consent to use private insurance is required to cover the cost of early intervention services and must be documented by service on the planned services screen in BRIDGES. It is the responsibility of the Service Coordinator to input the correct consent status. It may be necessary for the Service Coordinator to contact the insurance company to verify carrier codes and coverage. Please see Appendix C for additional guidance on this payor source. • Parental consent to use Medicaid is not required. • Services must be documented in the “Planned Services” section of the IFSP and prior authorization received (if required) before IFSP services can be initiated by the EIS provider. If the child is enrolled in one of SCDHHS’ Managed Care Organizations (MCO), the Service Coordinator must send a hardcopy of the IFSP and the MCO Universal BabyNet Prior Authorization (PA) form to the MCO for the PA process to proceed . Service Coordinators must correctly enter the following for each planned service: • Type of early intervention service • Name of EIS provider. • Name of licensed professional providing supervision to licensed therapy assistants. • The name of the individual providing supervision for service coordination can be entered for coverage of service coordination during staff absences or so they can access the record following staff resignation or termination. The Service Coordinator should follow their company/agency procedures in adding their supervisor as a separate line of service coordination in Planned Services. • Location in which service will be delivered. • How long (duration) the provider will work with the family and child (e.g., number of minutes per service event). • How often (frequency) the provider will work with the family and child (e.g., weekly, monthly, quarterly, twice a year). • The start date and end date the service is authorized for. All services must be reviewed and if appropriate reauthorized every six months through periodic review of the IFSP. In coordination with the SCDHHS Medicaid system, BRIDGES will ensure that IDEA/Part C service funds are used as payor of last resort. See procedures for System of Payments for documentation of parent consent to use private insurance. IFSP meetings must also be listed on the “Planned Services” section of the IFSP for each EIS Provider listed on the plan. EIS Provider Responsibilities in Service Provision: All EIS providers are responsible for making sure they review the IFSP in BRIDGES prior to rendering the service to ensure that information shown on the “Planned Services” screen is correct. Service events occurring outside the start date or end date will not be reimbursed. Following each service event, the EIS provider is responsible for entering a service log in BRIDGES within 7 calendar days. If the service was provided by a licensed therapy assistant, both Planned Services and service logs must reflect the supervision of the assistant at the frequency required by the South Carolina Department of Labor, Licensing, and Regulations (SCLLR). Procedures for Billing and Reimbursement for EIS Providers The fee schedules for IDEA/Part C services will match SCDHHS services, and can be found at xxxxx://xxxxxx.xxx/resource/fee-schedules. Steps for submission of claims and billing are included in APPENDIX C of this document. Appendix A: 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 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 Appendix B: Federal Definitions of Approved Procedure Codes for Early Intervention Services SERVICE DESCRIPTION: ASSISTIVE TECHNOLOGY – 34 CFR §303.13(B)(1LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency AUDIOLOGY EVALUATION and SERVICES 92557 - Audiological Consultation U1 Encounter 6 Per Year 92557 - Hearing Evaluation U2 Encounter 6 Per Year 92587 - Evoked Otoacoustic Emissions; (Evaluation) Assistive technology device means any itemEncounter 6 Per Year 92588 - Evoked Otoacoustic Emissions; (Screening) Encounter 12 Per Year 92620 - Auditory Evaluation with Report (60 Min.) Encounter 1 Per Encounter 92625 - Assessment of Tinnitus (Includes Pitch, piece of equipment or product systemLoudness Matching, whether acquired commercially off the shelf or modified or customizedAnd Masking) Encounter 1 Per Encounter 92626 - Evaluation Auditory Rehab Status 1St Hr. Encounter 10 Per Year V5020 - Conformity Evaluation Encounter 1 Per Encounter 92594 - Electroacoustic Eval Hearing Aid Monaural Encounter 6 Per Year 92595 - Electroacoustic Eval Hearing Aid Binaural Encounter 6 Per Year 92557 - Hearing Re-Evaluation Encounter 6 Per Year 92568 - Acoustic Reflex Testing; Threshold Encounter 1 Per Encounter 92550 - Tympanometry and Reflex Threshold Measurements Encounter 1 Per Encounter 92551 - Screening Test, that is used Pure Tone, Air Only Encounter 1 Per Encounter 92552 - Pure Tone Audiometry Air Only Encounter 6 Per Year 92553 - Pure Tone Audiometry Air & Bone Encounter 1 Per Encounter 92555 - Speech Audiometry Threshold Encounter 1 Per Encounter 92556 - Speech Audiometry Threshold Speech Recognition Encounter 1 Per Encounter 92563 - Tone Decay Test Encounter 1 Per Encounter 92567 - Tympanometry Encounter 6 Per Year 92570 - Tympanogram and Acoustic Reflexes Encounter 6 Per Year 92579 - Visual Reinforcement Audiometry Encounter 1 Per Encounter 92582 - Conditioning Play Audiometry Encounter 1 Per Encounter 92583 - Select Picture Audiometry Encounter 1 Per Encounter 92584 - Electrocochleography Encounter 1 Per Encounter 92586 - Auditory Evoked Potentials for Evoked Response / Audiometry Nerve Encounter 1 Per Encounter 92585 - Auditory Evoked Potentials for Evoked Response (Diagnostic) Encounter 1 Per Encounter 92590 - Hearing Aid Examination & Selection Monaural Encounter 6 Per Year 92591 - Hearing Aid Examination & Selection Binaural Encounter 6 Per Year 92592 - Hearing Aid Check Monaural Encounter 6 Per Year 92593 - Hearing Aid Check Binaural Encounter 6 Per Year V5275 - Ear Impression, Left LT Encounter 3 Per Year V5275 - Ear Impression, Right RT Encounter 3 Per Year V5011 - Fitting/Orientation/Checking Hearing Aid Encounter 1 Per Encounter V5264 - Ear Mold/Insert, Not Disposable, Any Type Encounter 1 Per Encounter V5090 - Dispensing Fee, Unspecified Hearing Aid Encounter 1 Per Encounter AUTISM EVALUATION 97151 - Behavior Identification Assessment Units 32 Lifetime AUTISM SERVICES 97153 - Adaptive Behavior Treatment Units 160 Week 97155 - Adaptive Behavior Treatment with Protocol Modification Units 64 Month 97156 - Family Adaptive Behavior Treatment Guidance Units 48 Year PSYCHOLOGICAL EVALUATION 96101 - Psychological Testing and Evaluation (Per Hour) Units 40 Lifetime 90791 - Psychiatric Diagnostic Evaluation Encounter 40 Lifetime 96130/96131 - Psychological testing and evaluation (1st 60 min/ Additional 60 min) Units 40 Lifetime 96136/96137 - Psychological testing (administration and scoring) (1st 30 min/ Additional 30 min) Units 40 Lifetime 96138/96139 - Psychological testing by technician (1st 30 min/ Additional 30 min) Units 40 Lifetime 96146 - Psychological testing (single standardized) Units 40 Lifetime 96112/96113 - Developmental testing (motor and language) (1st 60 min/ Additional 30 min) Units 40 Lifetime COUNSELING AND PSYCHOLOGICAL SERVICES 9940X - Prevent Med Counsel&/Risk Factor Encounter 1 Per Day MEDICAL EVALUATION 99381 - Initial Health Evaluation (Age 0 to increase1 Year) Encounter 1 Lifetime 99382 - Initial Health Evaluation (Age 1+) Encounter 1 Lifetime 99391 - Health Evaluation (Age 0 to 1 year) Encounter 1 Per Year 99392 - Health Evaluation (Age 1+) Encounter 1 Per Year SERVICE LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency NURSING EVALUATION T1001 - Nursing Assessment/Evaluation Encounter 48 Per Year NURSING SERVICES T1002 - RN Services, maintainUp To 15 Minutes Units 64 Per Month T1003 - LPN/LVN Services, or improve the developmental capabilities of children with disabilitiesUp To 15 Minutes Units 64 Per Month NUTRITION EVALUATION 97802 - Nutrition Assessment and Intervention; Initial Assessment Units 12 Per Year 97803 - Medical Nutrition Therapy; Re-Assessment and Intervention, Individual, Face-To- Face With T Units 12 Per Year NUTRITION SERVICES S9470 - Nutritional Counseling, Dietitian Visit Units 64 Per Month OCCUPATIONAL THERAPY EVALUATION 9716Y - Occupational Therapy Evaluation Encounter 2 Per Year 97168 - Occupational Therapy Re-evaluation Encounter 2 Per Year OCCUPATIONAL THERAPY SERVICES 97530 - Occupational Therapy Services (15 min.) GO Units 4 Per Day PHYSICAL THERAPY EVALUATION 9716X - Physical Therapy Evaluation Encounter 2 Per Year 97164 - Physical Therapy Re-evaluation (20 min.) Encounter 2 Per Year PHYSICAL THERAPY SERVICES 97110 - Physical Therapy Services (15 min. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization exercises) GP Unit 4 Per Day SOCIAL WORK SERVICES 9083X - Psychotherapy Encounter 8 Per Week SPEECH-LANGUAGE EVALUATION/RE-EVALUATION 92521 - Speech Evaluation (e.g., mapping), maintenance, or replacement of the device. Part C of IDEA deals only with assistive technology that is directly relevant to the developmental needs of the child. Assistive technology devices must assist the child in accomplishing functional IFSP goalsfluency) Encounter 1 Lifetime 92522 - Speech Evaluation (sound production) Encounter 1 Lifetime 92523 - Speech Evaluation (language comprehension) Encounter 1 Lifetime 92524 - Speech Evaluation (voice and resonance) Encounter 1 Lifetime 92610 - Speech Evaluation (oral/objectives within their everyday activities and routines. IDEA specifically excludes services that are surgical in nature and devices necessary to control or treat a medical condition. Equipmentpharyngeal wall) Encounter 1 Lifetime S9152 - Speech Therapy Re-evaluation Encounter 2 Per Year SPEECH-LANGUAGE PATHOLOGY SERVICES 92507 - Speech Therapy (voice command/Devices must be developmentally appropriate to be considered eligible for funding. Assistive technology service means a service that directly assists a child with a disability in the selection, acquisition, or auditory proc) Units 4 Per Day 92526 - Speech Therapy (swallowing/feeding) Units 4 Per Day 92609 - Speech Therapy (use of an assistive technology device. Assistive technology services include: • The evaluation of needs of an infant or toddler with a disability or developmental delay, including a functional evaluation of the child in the child’s natural/customary environment; • Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities or developmental delays; • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; • Coordinator and using other therapies, interventions, or services with assistive technology devices such as those associated with existing education and rehabilitation plans and programs; • Training or technical assistance for a child with developmental delays and that child’s family or caregiver; • Training or technical assistance for professional ) Encounter 1 Per Day VISION EVALUATION AND SERVICES 92002 -Vision Evaluation (including individuals providing IDEA/PART C Servicesnew patient intermediate) or other individuals who provide services to or are otherwise substantially involved in the major life functions of children with disabilities. All approved assistive technology devices will be reimbursed at the Medicaid DME reimbursement rate. Approved items not covered by Medicaid will be reimbursed at the manufactures suggested retail price. SERVICE DESCRIPTION: AUDIOLOGY – 34 CFR §303.13(B)(2Encounter 1 Lifetime 92004 - Vision Evaluation (new patient comprehensive) Audiology services include: • Identification of children with auditory impairment using appropriate audiological screening. • Determination of the range, nature, and degree of hearing loss and communication functions by use of audiological evaluation procedures. • Referral for medical and other services necessary for the habilitation and rehabilitation of children with hearing loss; • Attending IFSP meetings. • Provision of auditory training, aural rehabilitation, speech reading and listening device orientation/training, and other related services. • Provision of services for prevention of hearing loss. • Determination of the child’s need for individual amplification including selecting, fitting, and dispensing appropriate listening and vibrotactile devices. • Evaluating the effectiveness of assistive technology devices.Encounter 1 Lifetime 92012 - Vision Evaluation (established patient intermediate) Encounter 1 Per Year 92014 - Vision Evaluation (established patient comprehensive) Encounter 1 Per Year 92015 - Vision Evaluation Add-On - Refraction Test Encounter 1 Per Year SCSDB EVALUATION AND SERVICES
Appears in 1 contract
Samples: Autism Services
Service Coordinator Responsibilities in Service Provision. The Service Coordinator authorizes all services to be reimbursed by IDEA/Part C by placing them on the Individualized Family Service Plan (IFSP) in BRIDGES as follows: • If the family does not have Medicaid coverage, parental consent to use private insurance is required to cover the cost of early intervention services and must be documented by service on the planned services screen in BRIDGES. It is the responsibility of the Service Coordinator to input the correct consent status. It may be necessary for the Service Coordinator to contact the insurance company to verify carrier codes and coverage. Please see Attachment 3 of this Appendix C for additional guidance on this payor source. • Parental consent to use Medicaid is not required. • Services must be documented in the “Planned Services” section of the IFSP and prior authorization received (if required) before IFSP services can be initiated by the EIS provider. If the child is enrolled in one of SCDHHS’ Managed Care Organizations (MCO), the Service Coordinator must send a hardcopy of the IFSP and the MCO Universal BabyNet Prior Authorization (PA) form to the MCO for the PA process to proceed . Service Coordinators must correctly enter the following for each planned service: • Type of early intervention service • Name of EIS provider. • Name of licensed professional providing supervision to licensed therapy assistants. • The name of the individual providing supervision for service coordination can be entered for coverage of service coordination during staff absences or so they can access the record following staff resignation or termination. The Service Coordinator should follow their company/agency procedures in adding their supervisor as a separate line of service coordination in Planned Services. • Location in which service will be delivered. • How long (duration) the provider will work with the family and child (e.g., number of minutes per service event). • How often (frequency) the provider will work with the family and child (e.g., weekly, monthly, quarterly, twice a year). • The start date and end date the service is authorized for. All services must be reviewed and if appropriate reauthorized every six months through periodic review of the IFSP. In coordination with the SCDHHS Medicaid system, BRIDGES will ensure that IDEA/Part C service funds are used as payor of last resort. See procedures for System of Payments for documentation of parent consent to use private insurance. IFSP meetings must also be listed on the “Planned Services” section of the IFSP for each EIS Provider listed on the plan. EIS Provider Responsibilities in Service Provision: All EIS providers are responsible for making sure they review the IFSP in BRIDGES prior to rendering the service to ensure that information shown on the “Planned Services” screen is correct. Service events occurring outside the start date or end date will not be reimbursed. Following each service event, the EIS provider is responsible for entering a service log in BRIDGES within 7 calendar days. If the service was provided by a licensed therapy assistant, both Planned Services and service logs must reflect the supervision of the assistant at the frequency required by the South Carolina Department of Labor, Licensing, and Regulations (SCLLR). Procedures for Billing and Reimbursement for EIS Providers The fee schedules for IDEA/Part C services will match SCDHHS services, and can be found at xxxxx://xxxxxx.xxx/resource/fee-schedules. Steps for submission of claims and billing are included in APPENDIX C of this document. Appendix A: 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 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 Appendix B: Federal Definitions of Early Intervention Services SERVICE DESCRIPTION: ASSISTIVE TECHNOLOGY – 34 CFR §303.13(B)(1) Assistive technology device means any item, piece of equipment or product system, whether acquired commercially off the shelf or modified or customized, that is used to increase, maintain, or improve the developmental capabilities of children with disabilities. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization (e.g., mapping), maintenance, or replacement of the device. Part C of IDEA deals only with assistive technology that is directly relevant to the developmental needs of the child. Assistive technology devices must assist the child in accomplishing functional IFSP goals/objectives within their everyday activities and routines. IDEA specifically excludes services that are surgical in nature and devices necessary to control or treat a medical condition. Equipment/Devices must be developmentally appropriate to be considered eligible for funding. Assistive technology service means a service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device. Assistive technology services include: • The evaluation of needs of an infant or toddler with a disability or developmental delay, including a functional evaluation of the child in the child’s natural/customary environment; • Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities or developmental delays; • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; • Coordinator and using other therapies, interventions, or services with assistive technology devices such as those associated with existing education and rehabilitation plans and programs; • Training or technical assistance for a child with developmental delays and that child’s family or caregiver; • Training or technical assistance for professional (including individuals providing IDEA/PART C Services) or other individuals who provide services to or are otherwise substantially involved in the major life functions of children with disabilities. All approved assistive technology devices will be reimbursed at the Medicaid DME reimbursement rate. Approved items not covered by Medicaid will be reimbursed at the manufactures suggested retail price. SERVICE DESCRIPTION: AUDIOLOGY – 34 CFR §303.13(B)(2) Audiology services include: • Identification of children with auditory impairment using appropriate audiological screening. • Determination of the range, nature, and degree of hearing loss and communication functions by use of audiological evaluation procedures. • Referral for medical and other services necessary for the habilitation and rehabilitation of children with hearing loss; • Attending IFSP meetings. • Provision of auditory training, aural rehabilitation, speech reading and listening device orientation/training, and other related services. • Provision of services for prevention of hearing loss. • Determination of the child’s need for individual amplification including selecting, fitting, and dispensing appropriate listening and vibrotactile devices. • Evaluating the effectiveness of assistive technology devices.
Appears in 1 contract
Samples: Autism Services
Service Coordinator Responsibilities in Service Provision. The Service Coordinator authorizes all services to be reimbursed by IDEA/Part C by placing them on the Individualized Family Service Plan (IFSP) in BRIDGES as follows: • If the family does not have Medicaid coverage, parental consent to use private insurance is required to cover the cost of early intervention services and must be documented by service on the planned services screen in BRIDGES. It is the responsibility of the Service Coordinator to input the correct consent status. It may be necessary for the Service Coordinator to contact the insurance company to verify carrier codes and coverage. Please see Appendix C for additional guidance on this payor source. • Parental consent to use Medicaid is not required. • Services must be documented in the “Planned Services” section of the IFSP and prior authorization received (if required) before IFSP services can be initiated by the EIS provider. If the child is enrolled in one of SCDHHS’ Managed Care Organizations (MCO), the Service Coordinator must send a hardcopy of the IFSP and the MCO Universal BabyNet Prior Authorization (PA) form to the MCO for the PA process to proceed . Service Coordinators must correctly enter the following for each planned service: • Type of early intervention service • Name of EIS provider. • Name of licensed professional providing supervision to licensed therapy assistants. • The name of the individual providing supervision for service coordination can be entered for coverage of service coordination during staff absences or so they can access the record following staff resignation or termination. The Service Coordinator should follow their company/agency procedures in adding their supervisor as a separate line of service coordination in Planned Services. • Location in which service will be delivered. • How long (duration) the provider will work with the family and child (e.g., number of minutes per service event). • How often (frequency) the provider will work with the family and child (e.g., weekly, monthly, quarterly, twice a year). • The start date and end date the service is authorized for. All services must be reviewed and if appropriate reauthorized every six months through periodic review of the IFSP. In coordination with the SCDHHS Medicaid system, BRIDGES will ensure that IDEA/Part C service funds are used as payor of last resort. See procedures for System of Payments for documentation of parent consent to use private insurance. IFSP meetings must also be listed on the “Planned Services” section of the IFSP for each EIS Provider listed on the plan. EIS Provider Responsibilities in Service Provision: All EIS providers are responsible for making sure they review the IFSP in BRIDGES prior to rendering the service to ensure that information shown on the “Planned Services” screen is correct. Service events occurring outside the start date or end date will not be reimbursed. Following each service event, the EIS provider is responsible for entering a service log in BRIDGES within 7 calendar days. If the service was provided by a licensed therapy assistant, both Planned Services and service logs must reflect the supervision of the assistant at the frequency required by the South Carolina Department of Labor, Licensing, and Regulations (SCLLR). Procedures for Billing and Reimbursement for EIS Providers The fee schedules for IDEA/Part C services will match SCDHHS services, and can be found at xxxxx://xxxxxx.xxx/resource/fee-schedules. Steps for submission of claims and billing are included in APPENDIX C of this document. Appendix A: 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 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 Appendix B: Federal Definitions of Approved Procedure Codes for Early Intervention Services SERVICE DESCRIPTION: ASSISTIVE TECHNOLOGY – 34 CFR §303.13(B)(1LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency AUDIOLOGY EVALUATION and SERVICES 92557 - Audiological Consultation U1 Encounter 6 Per Year 92557 - Hearing Evaluation U2 Encounter 6 Per Year 92587 - Evoked Otoacoustic Emissions; (Evaluation) Assistive technology device means any itemEncounter 6 Per Year 92588 - Evoked Otoacoustic Emissions; (Screening) Encounter 12 Per Year 92620 - Auditory Evaluation with Report (60 Min.) Encounter 1 Per Encounter 92625 - Assessment of Tinnitus (Includes Pitch, piece of equipment or product systemLoudness Matching, whether acquired commercially off the shelf or modified or customizedAnd Masking) Encounter 1 Per Encounter 92626 - Evaluation Auditory Rehab Status 1St Hr. Encounter 10 Per Year V5020 - Conformity Evaluation Encounter 1 Per Encounter 92594 - Electroacoustic Eval Hearing Aid Monaural Encounter 6 Per Year 92595 - Electroacoustic Eval Hearing Aid Binaural Encounter 6 Per Year 92557 - Hearing Re-Evaluation Encounter 6 Per Year 92568 - Acoustic Reflex Testing; Threshold Encounter 1 Per Encounter 92550 - Tympanometry and Reflex Threshold Measurements Encounter 1 Per Encounter 92551 - Screening Test, that is used Pure Tone, Air Only Encounter 1 Per Encounter 92552 - Pure Tone Audiometry Air Only Encounter 6 Per Year 92553 - Pure Tone Audiometry Air & Bone Encounter 1 Per Encounter 92555 - Speech Audiometry Threshold Encounter 1 Per Encounter 92556 - Speech Audiometry Threshold Speech Recognition Encounter 1 Per Encounter 92563 - Tone Decay Test Encounter 1 Per Encounter 92567 - Tympanometry Encounter 6 Per Year 92570 - Tympanogram and Acoustic Reflexes Encounter 6 Per Year 92579 - Visual Reinforcement Audiometry Encounter 1 Per Encounter 92582 - Conditioning Play Audiometry Encounter 1 Per Encounter 92583 - Select Picture Audiometry Encounter 1 Per Encounter 92584 - Electrocochleography Encounter 1 Per Encounter 92586 - Auditory Evoked Potentials for Evoked Response / Audiometry Nerve Encounter 1 Per Encounter 92585 - Auditory Evoked Potentials for Evoked Response (Diagnostic) Encounter 1 Per Encounter 92590 - Hearing Aid Examination & Selection Monaural Encounter 6 Per Year 92591 - Hearing Aid Examination & Selection Binaural Encounter 6 Per Year 92592 - Hearing Aid Check Monaural Encounter 6 Per Year 92593 - Hearing Aid Check Binaural Encounter 6 Per Year V5275 - Ear Impression, Left LT Encounter 3 Per Year V5275 - Ear Impression, Right RT Encounter 3 Per Year V5011 - Fitting/Orientation/Checking Hearing Aid Encounter 1 Per Encounter V5264 - Ear Mold/Insert, Not Disposable, Any Type Encounter 1 Per Encounter V5090 - Dispensing Fee, Unspecified Hearing Aid Encounter 1 Per Encounter AUTISM EVALUATION 97151 - Behavior Identification Assessment Units 32 Lifetime AUTISM SERVICES 97153 - Adaptive Behavior Treatment Units 160 Week 97155 - Adaptive Behavior Treatment with Protocol Modification Units 64 Month 97156 - Family Adaptive Behavior Treatment Guidance Units 48 Year PSYCHOLOGICAL EVALUATION 96101 - Psychological Testing and Evaluation (Per Hour) Units 40 Lifetime 90791 - Psychiatric Diagnostic Evaluation Encounter 40 Lifetime 96130/96131 - Psychological testing and evaluation (1st 60 min/ Additional 60 min) Units 40 Lifetime 96136/96137 - Psychological testing (administration and scoring) (1st 30 min/ Additional 30 min) Units 40 Lifetime 96138/96139 - Psychological testing by technician (1st 30 min/ Additional 30 min) Units 40 Lifetime 96146 - Psychological testing (single standardized) Units 40 Lifetime 96112/96113 - Developmental testing (motor and language) (1st 60 min/ Additional 30 min) Units 40 Lifetime COUNSELING AND PSYCHOLOGICAL SERVICES 9940X - Prevent Med Counsel&/Risk Factor Encounter 1 Per Day MEDICAL EVALUATION 99381 - Initial Health Evaluation (Age 0 to increase1 Year) Encounter 1 Lifetime 99382 - Initial Health Evaluation (Age 1+) Encounter 1 Lifetime 99391 - Health Evaluation (Age 0 to 1 year) Encounter 1 Per Year 99392 - Health Evaluation (Age 1+) Encounter 1 Per Year SERVICE LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency NURSING EVALUATION T1001 - Nursing Assessment/Evaluation Encounter 48 Per Year NURSING SERVICES T1002 - RN Services, maintainUp To 15 Minutes Units 64 Per Month T1003 - LPN/LVN Services, or improve the developmental capabilities of children with disabilitiesUp To 15 Minutes Units 64 Per Month NUTRITION EVALUATION 97802 - Nutrition Assessment and Intervention; Initial Assessment Units 12 Per Year 97803 - Medical Nutrition Therapy; Re-Assessment and Intervention, Individual, Face-To- Face With T Units 12 Per Year NUTRITION SERVICES S9470 - Nutritional Counseling, Dietitian Visit Units 64 Per Month OCCUPATIONAL THERAPY EVALUATION 9716Y - Occupational Therapy Evaluation Encounter 2 Per Year 97168 - Occupational Therapy Re-evaluation Encounter 2 Per Year OCCUPATIONAL THERAPY SERVICES 97530 - Occupational Therapy Services (15 min.) GO Units 4 Per Week PHYSICAL THERAPY EVALUATION 9716X - Physical Therapy Evaluation Encounter 2 Per Year 97164 - Physical Therapy Re-evaluation (20 min.) Encounter 2 Per Year PHYSICAL THERAPY SERVICES 97110 - Physical Therapy Services (15 min. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization exercises) GP Unit 4 Per Day SOCIAL WORK SERVICES 9083X - Psychotherapy Encounter 8 Per Week SPEECH-LANGUAGE EVALUATION/RE-EVALUATION 92521 - Speech Evaluation (e.g., mapping), maintenance, or replacement of the device. Part C of IDEA deals only with assistive technology that is directly relevant to the developmental needs of the child. Assistive technology devices must assist the child in accomplishing functional IFSP goalsfluency) Encounter 1 Lifetime 92522 - Speech Evaluation (sound production) Encounter 1 Lifetime 92523 - Speech Evaluation (language comprehension) Encounter 1 Lifetime 92524 - Speech Evaluation (voice and resonance) Encounter 1 Lifetime 92610 - Speech Evaluation (oral/objectives within their everyday activities and routines. IDEA specifically excludes services that are surgical in nature and devices necessary to control or treat a medical condition. Equipmentpharyngeal wall) Encounter 1 Lifetime S9152 - Speech Therapy Re-evaluation Encounter 2 Per Year SPEECH-LANGUAGE PATHOLOGY SERVICES 92507 - Speech Therapy (voice command/Devices must be developmentally appropriate to be considered eligible for funding. Assistive technology service means a service that directly assists a child with a disability in the selection, acquisition, or auditory proc) Units 4 Per Day 92526 - Speech Therapy (swallowing/feeding) Units 4 Per Day 92609 - Speech Therapy (use of an assistive technology device. Assistive technology services include: • The evaluation of needs of an infant or toddler with a disability or developmental delay, including a functional evaluation of the child in the child’s natural/customary environment; • Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities or developmental delays; • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; • Coordinator and using other therapies, interventions, or services with assistive technology devices such as those associated with existing education and rehabilitation plans and programs; • Training or technical assistance for a child with developmental delays and that child’s family or caregiver; • Training or technical assistance for professional ) Encounter 1 Per Day VISION EVALUATION AND SERVICES 92002 -Vision Evaluation (including individuals providing IDEA/PART C Servicesnew patient intermediate) or other individuals who provide services to or are otherwise substantially involved in the major life functions of children with disabilities. All approved assistive technology devices will be reimbursed at the Medicaid DME reimbursement rate. Approved items not covered by Medicaid will be reimbursed at the manufactures suggested retail price. SERVICE DESCRIPTION: AUDIOLOGY – 34 CFR §303.13(B)(2Encounter 1 Lifetime 92004 - Vision Evaluation (new patient comprehensive) Audiology services include: • Identification of children with auditory impairment using appropriate audiological screening. • Determination of the range, nature, and degree of hearing loss and communication functions by use of audiological evaluation procedures. • Referral for medical and other services necessary for the habilitation and rehabilitation of children with hearing loss; • Attending IFSP meetings. • Provision of auditory training, aural rehabilitation, speech reading and listening device orientation/training, and other related services. • Provision of services for prevention of hearing loss. • Determination of the child’s need for individual amplification including selecting, fitting, and dispensing appropriate listening and vibrotactile devices. • Evaluating the effectiveness of assistive technology devices.Encounter 1 Lifetime 92012 - Vision Evaluation (established patient intermediate) Encounter 1 Per Year 92014 - Vision Evaluation (established patient comprehensive) Encounter 1 Per Year 92015 - Vision Evaluation Add-On - Refraction Test Encounter 1 Per Year SCSDB EVALUATION AND SERVICES
Appears in 1 contract
Samples: Autism Services
Service Coordinator Responsibilities in Service Provision. The Service Coordinator authorizes all services to be reimbursed by IDEA/Part C by placing them on the Individualized Family Service Plan (IFSP) in BRIDGES as follows: • If the family does not have Medicaid coverage, parental consent to use private insurance is required to cover the cost of early intervention services and must be documented by service on the planned services screen in BRIDGES. It is the responsibility of the Service Coordinator to input the correct consent status. It may be necessary for the Service Coordinator to contact the insurance company to verify carrier codes and coverage. Please see Attachment 3 of this Appendix C for additional guidance on this payor source. • Parental consent to use Medicaid is not required. • Services must be documented in the “Planned Services” section of the IFSP and prior authorization received (if required) before IFSP services can be initiated by the EIS provider. If the child is enrolled in one of SCDHHS’ Managed Care Organizations (MCO), the Service Coordinator must send a hardcopy of the IFSP and the MCO Universal BabyNet Prior Authorization (PA) form to the MCO for the PA process to proceed . Service Coordinators must correctly enter the following for each planned service: • Type of early intervention service • Name of EIS provider. • Name of licensed professional providing supervision to licensed therapy assistants. • The name of the individual providing supervision for service coordination can be entered for coverage of service coordination during staff absences or so they can access the record following staff resignation or termination. The Service Coordinator should follow their company/agency procedures in adding their supervisor as a separate line of service coordination in Planned Services. • Location in which service will be delivered. • How long (duration) the provider will work with the family and child (e.g., number of minutes per service event). • How often (frequency) the provider will work with the family and child (e.g., weekly, monthly, quarterly, twice a year). • The start date and end date the service is authorized for. All services must be reviewed and if appropriate reauthorized every six months through periodic review of the IFSP. In coordination with the SCDHHS Medicaid system, BRIDGES will ensure that IDEA/Part C service funds are used as payor of last resort. See procedures for System of Payments for documentation of parent consent to use private insurance. IFSP meetings must also be listed on the “Planned Services” section of the IFSP for each EIS Provider listed on the plan. EIS Provider Responsibilities in Service Provision: All EIS providers are responsible for making sure they review the IFSP in BRIDGES prior to rendering the service to ensure that information shown on the “Planned Services” screen is correct. Service events occurring outside the start date or end date will not be reimbursed. Following each service event, the EIS provider is responsible for entering a service log in BRIDGES within 7 calendar days. If the service was provided by a licensed therapy assistant, both Planned Services and service logs must reflect the supervision of the assistant at the frequency required by the South Carolina Department of Labor, Licensing, and Regulations (SCLLR). 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 will match SCDHHS services, and can be found at xxxxx://xxxxxx.xxx/resource/fee-schedules. Please note that only the codes listed on the table in Appendix A are reimbursable. Additional procedure codes on the fee schedules, but not listed in the code table, are not reimbursable. Steps for submission of claims and billing are included in APPENDIX C Attachment 3 of this documentAppendix. Appendix AAttachment 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 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 Appendix BAttachment 2: Federal Definitions of Approved Procedure Codes for Early Intervention Services SERVICE DESCRIPTIONLOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency AUDIOLOGY EVALUATION and SERVICES 92557 - Audiological Consultation U1 Encounter 6 Per Year 92557 - Hearing Evaluation U2 Encounter 6 Per Year 92587 - Evoked Otoacoustic Emissions; (Evaluation) Encounter 6 Per Year 92588 - Evoked Otoacoustic Emissions; (Screening) Encounter 12 Per Year 92620 - Auditory Evaluation with Report (60 Min.) Encounter 1 Per Encounter 92625 - Assessment of Tinnitus (Includes Pitch, Loudness Matching, And Masking) Encounter 1 Per Encounter 92626 - Evaluation Auditory Rehab Status 1St Hr. Encounter 10 Per Year V5020 - Conformity Evaluation Encounter 1 Per Encounter 92594 - Electroacoustic Eval Hearing Aid Monaural Encounter 6 Per Year 92595 - Electroacoustic Eval Hearing Aid Binaural Encounter 6 Per Year 92557 - Hearing Re-Evaluation Encounter 6 Per Year 92568 - Acoustic Reflex Testing; Threshold Encounter 1 Per Encounter 92550 - Tympanometry and Reflex Threshold Measurements Encounter 1 Per Encounter 92551 - Screening Test, Pure Tone, Air Only Encounter 1 Per Encounter 92552 - Pure Tone Audiometry Air Only Encounter 6 Per Year 92553 - Pure Tone Audiometry Air & Bone Encounter 1 Per Encounter 92555 - Speech Audiometry Threshold Encounter 1 Per Encounter 92556 - Speech Audiometry Threshold Speech Recognition Encounter 1 Per Encounter 92563 - Tone Decay Test Encounter 1 Per Encounter 92567 - Tympanometry Encounter 6 Per Year 92570 - Tympanogram and Acoustic Reflexes Encounter 6 Per Year 92579 - Visual Reinforcement Audiometry Encounter 1 Per Encounter 92582 - Conditioning Play Audiometry Encounter 1 Per Encounter 92583 - Select Picture Audiometry Encounter 1 Per Encounter 92584 - Electrocochleography Encounter 1 Per Encounter 92586 - Auditory Evoked Potentials for Evoked Response / Audiometry Nerve Encounter 1 Per Encounter 92585 - Auditory Evoked Potentials for Evoked Response (Diagnostic) Encounter 1 Per Encounter 92590 - Hearing Aid Examination & Selection Monaural Encounter 6 Per Year 92591 - Hearing Aid Examination & Selection Binaural Encounter 6 Per Year 92592 - Hearing Aid Check Monaural Encounter 6 Per Year 92593 - Hearing Aid Check Binaural Encounter 6 Per Year V5275 - Ear Impression* Encounter 3 Per Year V5011 - Fitting/Orientation/Checking Hearing Aid Encounter 1 Per Encounter V5264 - Ear Mold/Insert, Not Disposable, Any Type Encounter 1 Per Encounter V5090 - Dispensing Fee, Unspecified Hearing Aid Encounter 1 Per Encounter *If billing V5275, enter one unit if billing for only one ear impression, no modifier. Enter 2 units if billing for 2 impressions, no modifier. Number of units is limited 6/year. AUTISM EVALUATION 97151 - Behavior Identification Assessment Units 32 Lifetime AUTISM SERVICES 97153 - Adaptive Behavior Treatment Units 160 Week 97155 - Adaptive Behavior Treatment with Protocol Modification Units 64 Month 97156 - Family Adaptive Behavior Treatment Guidance Units 48 Year PSYCHOLOGICAL EVALUATION 96101 - Psychological Testing and Evaluation (Per Hour) Units 40 Lifetime 90791 - Psychiatric Diagnostic Evaluation Encounter 40 Lifetime 96130/96131 - Psychological testing and evaluation (1st 60 min/ Additional 60 min) Units 40 Lifetime 96136/96137 - Psychological testing (administration and scoring) (1st 30 min/ Additional 30 min) Units 40 Lifetime 96138/96139 - Psychological testing by technician (1st 30 min/ Additional 30 min) Units 40 Lifetime 96146 - Psychological testing (single standardized) Units 40 Lifetime 96112/96113 - Developmental testing (motor and language) (1st 60 min/ Additional 30 min) Units 40 Lifetime COUNSELING AND PSYCHOLOGICAL SERVICES 9940X - Prevent Med Counsel&/Risk Factor Encounter 1 Per Day MEDICAL EVALUATION 99381 - Initial Health Evaluation (Age 0 to 1 Year) Encounter 1 Lifetime 99382 - Initial Health Evaluation (Age 1+) Encounter 1 Lifetime 99391 - Health Evaluation (Age 0 to 1 year) Encounter 1 Per Year 99392 - Health Evaluation (Age 1+) Encounter 1 Per Year NURSING EVALUATION T1001 - Nursing Assessment/Evaluation Encounter 48 Per Year NURSING SERVICES T1002 - RN Services, Up To 15 Minutes Units 64 Per Month T1003 - LPN/LVN Services, Up To 15 Minutes Units 64 Per Month NUTRITION EVALUATION 97802 - Nutrition Assessment and Intervention; Initial Assessment Units 12 Per Year SERVICE LOG DROP DOWN CATEGORY with PROCEDURE CODE DESCRIPTION LIST Modifier Pay Per BN Service Limit Count BN Service Limit Frequency 97803 - Medical Nutrition Therapy; Re-Assessment and Intervention, Individual, Face-To-Face With T Units 12 Per Year NUTRITION SERVICES S9470 - Nutritional Counseling, Dietitian Visit Units 64 Per Month OCCUPATIONAL THERAPY EVALUATION 9716Y - Occupational Therapy Evaluation Encounter 2 Per Year 97168 - Occupational Therapy Re-evaluation Encounter 2 Per Year OCCUPATIONAL THERAPY SERVICES 97530 - Occupational Therapy Services (15 min.) GO Units 4 Per Day PHYSICAL THERAPY EVALUATION 9716X - Physical Therapy Evaluation Encounter 2 Per Year 97164 - Physical Therapy Re-evaluation (20 min.) Encounter 2 Per Year PHYSICAL THERAPY SERVICES 97110 - Physical Therapy Services (15 min. exercises) GP Units 4 Per Day 97530 - Physical Therapy Services (15 min. exercises) GP Units 4 Per Day SOCIAL WORK SERVICES 9083X - Psychotherapy Encounter 8 Per Week SPEECH-LANGUAGE EVALUATION/RE-EVALUATION 92521 - Speech Evaluation (fluency) Encounter 1 Lifetime 92522 - Speech Evaluation (sound production) Encounter 1 Lifetime 92523 - Speech Evaluation (language comprehension) Encounter 1 Lifetime 92524 - Speech Evaluation (voice and resonance) Encounter 1 Lifetime 92610 - Speech Evaluation (oral/pharyngeal wall) Encounter 1 Lifetime S9152 - Speech Therapy Re-evaluation Encounter 2 Per Year SPEECH-LANGUAGE PATHOLOGY SERVICES 92507 - Speech Therapy (voice command/auditory proc) Units 4 Per Day 92526 - Speech Therapy (swallowing/feeding) Units 4 Per Day 92609 - Speech Therapy (use of device) Encounter 1 Per Day VISION EVALUATION AND SERVICES 92002 -Vision Evaluation (new patient intermediate) Encounter 1 Lifetime 92004 - Vision Evaluation (new patient comprehensive) Encounter 1 Lifetime 92012 - Vision Evaluation (established patient intermediate) Encounter 1 Per Year 92014 - Vision Evaluation (established patient comprehensive) Encounter 1 Per Year 92015 - Vision Evaluation Add-On - Refraction Test Encounter 1 Per Year SCSDB EVALUATION AND SERVICES Interpretation: Deaf and Hard of Hearing Units 8 Per Day Cued Language Units 4 Per Day T1024 - Orientation and Mobility Evaluation U3 Units 8 Lifetime T1024 - Orientation and Mobility Instruction U2 Units 30 Per Week IFSP MEETING-SERVICE COORDINATION T1018 - Family Training IFSP Meeting TL Units 8 Per Day IFSP MEETING-SERVICE PROVIDERS (ALL) T1024 - IFSP Team Meeting/Participation (Team Members) Units 8 Per Day SERVICE COORDINATION T1016 - Service Coordination TL Units 16 Per Day FAMILY TRAINING, COUNSELING, AND HOME VISITS (SPECIAL INSTRUCTION SERVICES) T1027 - Family Training & Counseling (15 Min.) TL Units 4 Per Day FOREIGN LANGUAGE SERVICES FLT00- Foreign Language Translation Units 6 Per IFSP FLI00- Foreign Language Interpretation Units 12 Daily TRANSPORTATION AND RELATED COSTS TT000- Transportation-Taxi Miles No limit No limit TFA00- Transportation-Family Auto Miles No limit No limit TO000- Transportation-Other Miles No limit No limit ASSISTIVE TECHNOLOGY – 34 CFR §303.13(B)(1) TECHOLOGY SERVICES AND DEVICES ATDAS- Assistive technology device means any item, piece of equipment or product system, whether acquired commercially off the shelf or modified or customized, that is used to increase, maintain, or improve the developmental capabilities of children with disabilities. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization (e.g., mapping), maintenance, or replacement of the device. Technology Services and Devices Units As Approved As Approved Step Submitting Claims for IDEA/Part C of IDEA deals only Early Intervention Services 1 Provider confirms with Service Coordinator that service payor is correct in BRIDGES. NOTE: IDEA/Part C must always be Payor 1 for all assistive technology that is directly relevant to the developmental needs of the child. Assistive technology devices must assist the child in accomplishing functional IFSP goals/objectives within their everyday activities services and routines. IDEA specifically excludes services that are surgical in nature and devices necessary to control or treat a medical condition. Equipment/Devices must be developmentally appropriate to be considered eligible for funding. Assistive technology service means a service that directly assists a child with a disability in the selectiondevices, acquisitionforeign language interpretation, or use of an assistive technology device. Assistive technology services include: • The evaluation of needs of an infant or toddler with a disability or developmental delayforeign language translation, including a functional evaluation of the child in the child’s natural/customary environment; • Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities or developmental delays; • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; • Coordinator and using other therapies, interventions, or services with assistive technology devices such as those associated with existing education and rehabilitation plans and programs; • Training or technical assistance for a child with developmental delays and that child’s family or caregiver; • Training or technical assistance for professional (including individuals providing IDEA/PART C Services) or other individuals who provide services to or are otherwise substantially involved in the major life functions of children with disabilities. All approved assistive technology devices will be reimbursed at the Medicaid DME reimbursement rate. Approved items not covered by Medicaid will be reimbursed at the manufactures suggested retail price. SERVICE DESCRIPTION: AUDIOLOGY – 34 CFR §303.13(B)(2) Audiology services include: • Identification of children with auditory impairment using appropriate audiological screening. • Determination of the range, naturetransportation, and degree of hearing loss and communication functions by use of audiological evaluation procedures. • Referral for medical and other services necessary for the habilitation and rehabilitation of children with hearing loss; • Attending IFSP meetings. • Provision of auditory training, aural rehabilitation, speech reading and listening device orientation/training, and other related compensatory services. • Provision NOTE: Private Insurance will never be Payor 1 for service coordinator or special instruction services. 2 Provider secures Prior Authorization from payor source before initiation of services for prevention of hearing loss(see table below). • Determination of the child’s need for individual amplification including selecting, fitting, 3 Provider delivers services as documented in IFSP. 4 Provider enters service log in BRIDGES and dispensing appropriate listening and vibrotactile devices. • Evaluating the effectiveness of assistive technology devicesclicks ‘Save.’ 5 The saved service log is captured as BRIDGES Accounts Payable journal entry.
Appears in 1 contract
Samples: msp.scdhhs.gov
