Medicaid Billing Module Physical Therapy Billing Form August, 2017

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Medicaid Billing Module Physical Therapy Billing Form August, 2017

Consent to Bill Medicaid Prior to billing parents must provide written consent to release information and to bill for Medicaid reimbursement. Consent is only good for one calendar year. Parents are to be provided an annual notice. 2

Physical Therapy Billing Form Services must be documented on Service Care Plan signed by the parent and therapist. Specific ICD-10 diagnosis codes are required. ICD-10 codes must relate to the specific type of therapy being provided. Think of these more as treatment diagnosis codes. A global code such as Cerebral Palsy would not be sufficient. 3

Physician Authorization Form Physician Authorization is required annually to bill for Physical therapy. The PT lists suggested ICD-10 diagnosis codes that specifically relate to the therapy being provided. When the physician signs the authorization form they are confirming the therapist’s code(s). Authorizations can be signed by a Physician (MD or DO), Physician’s Assistant (PA) or by an Advanced Practice Registered Nurse (APRN). 4

Student Demographics Use the student’s real name as listed in WVEIS The diagnosis code is to be an ICD-10 code that matches the need for physical therapy. County and school names can be written out or use the county and school WVEIS codes. For provider name print the name of the person providing the service. 5

Procedure Codes Complete beginning and end dates for each procedure. Enter the appropriate procedure code from those listed on the form. Use a separate line for each procedure code being provided during the month. List the total number of units for the month for each procedure. (Units cannot be rounded but can be added together within the same calendar month) The form is to be used for only one calendar month. 6

Procedure Code Changes As of January 1, 2017, there is a new procedure codes for re-evaluations. As of January 1, 2017, there are three separate procedure codes for an evaluation. The evaluator must determine the complexity level of the evaluation choosing from low, moderate or high. Only one of the three evaluations can be billed during the same calendar month. 7

Student Demographics and Procedures Sample Medicaid Number Last Name First Name 0000000000 Doe Jane WVEIS # Diagnosis Code Date of Birth 999999999 01-01-1900 County 1 Beginning Date 1 Ending Date 1 Procedure Code Units 059 09/01/2015 09/30/2015 97110 GP 10 School 2 Beginning Date 2 Ending Date 2 Procedure Code Units 203 09/01/2015 09/30/2015 97116 GP 5 Provider Name 3 Beginning Date 3 Ending Date 3 Procedure Code Units 09/01/2015 09/30/2015 97164 GP 1

Explanation of Procedures and Caps Part 1 97161 GP Physical Therapy Evaluation Low Complexity 1 event per calendar year 97162 GP Physical Therapy Evaluation Moderate Complexity 1 event per calendar year 97163 GP Physical Therapy Evaluation High Complexity 1 event per calendar year 97164 GP Physical Therapy Re-evaluation 2 events per calendar year 97032 GP Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes 20 units per month 97110 GP Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility each 15 minutes 20 units per month 97112 GP Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception for sitting and/or standing activities, each 15 minutes 20 units per month 97113 GP Aquatic Therapy with therapeutic exercises, each 15 minutes 20 units per month

Explanation of Procedures and Caps Part 2 97116 GP Gait training (includes stair climbing) each 15 minutes 20 units per month 97150 GP Therapeutic procedure(s), group (2 or more individuals), each 15 minutes. 20 units per month 97140 GP Manual therapy techniques (mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions each 15 minutes 20 units per month 97530 GP Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance) each 15 minutes 20 units per month 97532 GP Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training), direct (one-on-one) patient contact by the provider each 15 minutes 20 units per month 97533 GP Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes 20 units per month

Start and Stop Times Enter the start and stop times for each service on the corresponding date at the bottom of the form. These will be used to easily identify dates billable services were conducted for students with transportation services. If using multiple procedure codes within a session or day, each procedure code needs to have a separate start and stop time. See the PT sample form for an example of how to document on the form.

Start and Stop Times Date Start Time End Time 1 Date Start Time End Time 16 2 17 3 4 5 6 18 19 20 21 7 22 8 23 9 24 10 25 11 26 27 12 28 13 29 14 30 15 31

Physical Therapy Assistant (PTA) PTAs can only bill for therapy when a Physical Therapist (PT) certified by the WV Board of Examiners is directly supervising. Directly supervising requires the Board Certified PT to be on site when the therapy is being provided. PTA progress/therapy logs are to be co-signed by the supervising PT for therapy dates that are billed for Medicaid. This only applies to dates when the PT was directly supervising the PTA. To make this clear to the person entering billing the PT should initial the days that they provided direct supervision. PTAs can not bill for evaluations.

Additional Documentation Progress/therapy logs will also be required. Original copies of progress/therapy logs must be on file in the special education central office. There is not a required form for documentation of progress/therapy logs.

Signature and Credentials Staff who provided or directly supervised the service will sign the form and list credentials. For PTAs, the supervising PT must co-sign the billing form.

Terry Riley – Coordinator Office of Special Education [email protected] 304-558-2696 ext 53223 WVDE Medicaid Website: http://

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