According to Georgia Medicaid guidelines, childrens intervention services must be reported with modifier HA (Child/adolescent program) and are allowed only for Medicaid eligible members less than 21 years of age. Please enable Cookies and reload the page. Learn moreabout how we provide comprehensive support for members. https://suicidepreventionlifeline.org/, Local and regional calls are routed from the National Suicide Prevention Lifeline to DBHDDs Georgia Crisis and Access Line (GCAL) 1-800-715-4225 https://dbhdd.georgia.gov/access-services, Voices for Georgias Children has given permission and provided the following video on Suicide Prevention: https://vimeo.com/270156589, http://georgiavoices.org/videos/suicide-prevention-psas-2/. Please note that the reimbursement rate sheets (R-32) are in alphabetical order. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. @,[whrDK 8v`{w)[A!#M~F1" &(BP hVQo8+zz$[! Health care claims payment policies are guidelines used to assist in administering payment rules based on generally accepted principles of correct coding. PDF Attachment 4.19 - B State Georgia POLICY AND METHODS FOR ESTABLISHING According to Georgia Medicaid guidelines, the telehealth originating site facility fee must be reported with modifier EP (EPSDT program) and modifier GT (Via interactive audio or video telecommunication systems) when billed in a school setting. These services are provided by speech-language-pathologists %PDF-1.7 % These proprietary policies are not a guarantee of payment. c. Please locate the pdf file where the Provider's Name would fall. 455 0 obj <> endobj According to Georgia Medicaid guidelines, children's intervention services must be reported with modifier HA (Child/adolescent . Physical Therapy Speech Therapy Occupational Therapy Home Health Aide Cost Report Reference / Formula; Build-Up (All Agencies Statewide) 35) Total Allowable Costs (All Agencies Statewide) Sch. The Children's Intervention Services (CIS) Program provides coverage for restorative and rehabilitative services including audiology, health and behavior assessments, nursing services, nutrition services, occupational therapy, orthotic and prosthetic training, physical therapy and speech-language pathology. endstream endobj 459 0 obj <>stream FY 2021 revised rates inclusive of 18.37% Growth and Quality Incentive Please note that the reimbursement rate sheets (R-32) are in alphabetical order. These rates are inclusive of 13.37% Growth, Joint Commission & AHCA quality incentives and audited 2018 GL/PL Insurance Costs. Web form outage is expected around 5:30pm on April 28, 2023. Press Space or Escape to collapse the expanded menu item. Policies in the Peach State Health PlanPayment Policy Manual may have either a Peach State Health Planor a Centene heading. Under the FFS model, Georgia pays providers directly for each covered service received by a Medicaid beneficiary. The CMOs authorize and reimburse services through provider networks found here: Amerigroup: https://www.myamerigroup.com/ga/georgia-home.html, Wellcare: https://www.wellcare.com/Georgia, Peach State: https://www.pshpgeorgia.com/, Care Source: https://www.caresource.com/ga/, The National Suicide Prevention Lifeline is a United States-based suicide prevention network of 161 crisis centers that provides a 24/7, toll-free hotline available to anyone in suicidal crisis or emotional distress. Georgia Medicaid Georgia Medicaid Coverage of Therapy Services The analysis of any legal or medical billing is dependent on numerous specific facts including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Effective January 24, 2021 a significant enhancement to our physician reimbursement policies that promote correct coding. Georgia Georgia Medicaid Coverage of Therapy Services Georgia Medicaid Coverage of Therapy Services Guidance on therapy services covered through Georgia Medicaid and other important compliance issues such as enrollment, billing, audits, and managed care. Speech Therapy and Audiology Fee Schedule - Jan. 5, 2022 - PDF <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> In general, Georgia set provider payments under fee-for-service. Wellcare uses cookies. How do I know if I am in the right place? All policies found in the Peach State Health Plan Clinical Policy Manual apply to Peach State Health Plan members. 2021 Medicaid Enhancements to Reimbursement Policies. Community providers of behavioral health services can be accessed by contacting The Georgia Crisis and Access Line (GCAL) at 800-715-4225 or via the web by visiting www.mygcal.com . Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Reimbursement policies are designed to assist you when submitting claims to CareSource. Press Enter or Space to expand a menu item, and Tab to navigate through the items. If the screening is missed, it may be performed during a catch-up visit using modifier EP and HA or UA. Physical, Occupational, and Speech Therapy Services (PDF) CP.MP.49: June 30, 2021: . It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. Speech Therapy and Language Disorder Rehabilitation GEORGIA MEDICAID MM-0714 Effective Date: 10/01/2020 Outpatient Speech Therapy and Language Disorder Rehabilitation B. hbbd```b`` 3a, Col 003, line 019: 36) Capital Related - Buildings & Fixtures (All Agencies Statewide) Sch. This change is estimated to increase E&D Waiver expenditures for SFY 2022 as follows: The Georgia General Assembly passed legislation to increase Elderly and Disabled Waiver rates by 10% effective July 1, 2021. 491 0 obj <>stream <> Background Speech language pathology services include the diagnosis and treatment of speech and language disorders. Speech Therapy and Audiology Fee Schedule - Jan. 5, 2022 - PDF. Download the free version of Adobe Reader. Completing the CAPTCHA proves you are a human and gives you temporary access to the web property. They are routinely updated to promote accurate coding and policy clarification. These proprietary policies are not a guarantee of payment. They include, but are not limited to claims processing guidelines referenced by the Centers for Medicare and Medicaid Services (CMS), Publication 100-04, Claims Processing Manual for physicians/non-physician practitioners, the CMS National Correct Coding Initiative policy manual (procedure-to-procedure coding combination edits and medically unlikely edits), Current Procedural Technology guidance published by the American Medical Association (AMA) for reporting medical procedures and services, health plan clinical policies based on the appropriateness of health care and medical necessity, and at times state-specific claims reimbursement guidance. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Clinical policies help identify whether services are medically necessary based on information found in generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by the policy; and other available clinical information. Principal Appropriate Utilization Group, LLC 881 Piedmont Avenue Atlanta, GA 30309 (404) 728-1974; FAX (404) 728-1975 [email protected] Local, state, and federal government websites often end in .gov. As Georgia's Behavioral Health Authority, DBHDD provides services through a network of community providers. Additionally, the following implantable contraceptive devices and procedures should be reported with modifier FP (Service provided as part of Medicaid family planning program): According to Georgia Medicaid guidelines, hearing aid devices, items and services are not covered for patients 21 years of age or older. How you know. Provider Fee Payment | Georgia Department of Community Health The Lifeline supports people who call for themselves or someone they care about. According to Georgia Medicaid guidelines, early and periodic screening, diagnostic and treatment (EPSDT) services should follow the recommended age requirement indicated in the American Academy of Pediatrics (AAP) and Bright Futures 'Recommendations for Pediatric Health Care' periodicity schedule. endobj Appropriate Use and Safety Edits: Attachment A(PDF), Pharmacy Prior Authorization and Medical Necessity Criteria (PDF). Additionally, laws and regulations and insurance and payer policies are subject to change. If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware. Reimbursement rates have been recalculated effective July 1, 2020 through June 30, 2021. NC Medicaid Contact Center State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. They are used to help identify whether health care services are correctly coded for reimbursement. b. Enrollment Forms Additional information on available services and policy requirements can be obtained by visiting https://dbhdd.georgia.gov/community-provider-manuals. Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices. aJY $,0V #hE2!FF!&`B+4fC&%@ c cTh These rates are inclusive of 13.37% Growth and audited 2018 GL/PL Insurance Costs. You do not have JavaScript Enabled on this browser. Georgia Medicaid offers benefits on a Fee-for-Service (FFS) basis or through managed care plans. The Reimbursement rates for FYE June 30, 2020, are located below. The Department of Community Health (DCH) administers Medicaid reimbursement and associated policy for mental health treatment and services through partnership with The Department of Behavioral Health and Developmental Disabilities (DBHDD). Medicaid Coverage of Speech-Language Pathologists and Audiologists . The National Drug Code (NDC) is a unique, three-segment number that identifies a drug. First Published . Answers to frequently asked questions about Medicaid and audiology and speech-language pathology services. occupational therapy, and services for individuals with speech, hearing and language disorders; . Please locate the pdf file where the Provider's Name would fall. Reimbursement rates have been recalculated effective July 1, 2020 through June 30, 2021. 322.9. Diaphragm fitting, condoms and contraceptive injection of medroxyprogesterone acetate must be submitted with modifier FP (Service provided as part of Medicaid family planning program). Therefore, the EPSDT service will be recommended for denial when outside of the required age recommendation: According to Georgia Medicaid guidelines, developmental and/or autism screenings are allowed for patients nine months, 18 months and 30 months of age. Online Form. We believe that this will enable you and your billing staff to better understand our claims payment process given the widespread use of these policies. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Press Tab or Shift+Tab to navigate through menu. Office of Analytics and Program Improvement, Medicaid Promoting Interoperability Program. The Department also received approval for quality incentives related to the Joint Commission and American Health Care Association (AHCA) Accreditation effective August 14, 2020. Therapy Comply does not claim copyright over US Federal and State materials. States have great flexibility in how Medicaid payments are made to . Speech Therapy and Audiology Fee Schedule - Jan. 5, 2022 - PDF. PDF 74.88 KB - January 05, 2022 Division/Office. endstream endobj 456 0 obj <>/Metadata 27 0 R/Pages 453 0 R/StructTreeRoot 49 0 R/Type/Catalog/ViewerPreferences 472 0 R>> endobj 457 0 obj <>/MediaBox[0 0 612 792]/Parent 453 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 458 0 obj <>stream Get Contracted by following the link below. The Initial Reimbursement Rate Sheets for FYE June 30, 2022, are located below. >->}2Ou+@BRdCH4\dWMZ5S8p~]uQDi/@_We:67 8j|UCo*g~~PmN jtM+C ;y}wnUx https://dbhdd.georgia.gov/community-provider-manuals, https://www.myamerigroup.com/ga/georgia-home.html, https://dbhdd.georgia.gov/access-services, Mental Health and Substance Use Disorder Parity. In addition, Peach State Health Planmay from time to time delegate utilization management of specific services; in such circumstances, the delegated vendors guidelines may also be used to support medical necessity and other coverage determinations. Authorization for Cancer Treatment/New Century Health, 25-Hydroxyvitamin D Testing in Children and Adolescents (PDF), Allogeneic Hematopoietic Cell Transplants for Sickle Cell(PDF), Ambulatory Surgery Center Optimization (PDF), Cosmetic and Reconstructive Surgery (PDF), Diaphragmatic/Phrenic Nerve Stimulation (PDF), Drugs of Abuse: Definitive Testing (PDF), Facility-based Sleep Studies for Obstructive Sleep Apnea (PDF), Genetic Testing Aortopathies and Connective Tissue Disorder (PDF), Genetic Testing Dermatologic Conditions (PDF), Genetic Testing Epilepsy Neurodegenerative Neuromuscular Disorder (PDF), Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF), Genetic Testing Gastroenterologic Disorders (non-cancerous) (PDF), Genetic Testing General Approach to Genetic Testing (PDF), Genetic Testing Hematologic Conditions (non-cancerous) (PDF), Genetic Testing Hereditary Cancer Susceptibility (PDF), Genetic Testing Immune Autoimmune and Rheumatoid Disorders (PDF), Genetic Testing Metabolic Endocrine and Mitochondrial Disorders(PDF), Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay(PDF), Genetic Testing Non-Invasive Prenatal Screening (NIPS)(PDF), Genetic Testing Preimplantation Genetic Testing(PDF), Genetic Testing Prenatal and Precon Carrier Screening(PDF), Genetic Testing Prenatal Diagnosis (via Amnio CVS or PUBS) and Pregnancy Loss(PDF), Genetic Testing Skeletal Dysplasia and Rare Bone Disorders(PDF), Helicobacter Pylori Serology Testing (PDF), Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (PDF), Implantable Wireless Pulmonary Artery Pressure Monitoring (PDF), Infant Apnea Monitors Clinical Policy (PDF), Intestinal and Multivisceral Transplant (PDF), Intradiscal Steroid Injections for Pain Management(PDF), IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures(PDF), Low-Frequency Ultrasound Therapy for Wound Management (PDF), Measurement of Serum 1,25-dihydroxyvitamin D (PDF), Neonatal Abstinence Syndrome Guidelines (PDF), Nerve Blocksand Neurolysis for Pain Management (PDF), Neuromuscular Electrical Stimulation (PDF), Nonmyeloablative Allogeneic Stem Cell Transplants (PDF), Oncology Circulating Tumor DNA and Circulating Tumor Cells (PDF), Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF), Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (PDF), Phototherapy for Neonatal Hyperbilirubinemia(PDF), Physical, Occupational, and Speech Therapy Services (PDF), Physical, Occupational, Speech, and Feeding Therapy (PDF), Posterior Tibial Nerve Stimulation for Voiding Dysfunction (PDF), Reduction Mammoplasty and Gynecomastia Surgery (PDF), Sacroiliac Joint Interventions for Pain Management (PDF), Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins(PDF), Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy (PDF), Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management (PDF), Skin Substitutes for Chronic Wounds (PDF), Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (PDF), Stereotactic Body Radiation Therapy (PDF), Testing for Select Genitourinary Conditions (PDF), Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (PDF), Transcather Closer of Patent Foramen Ovale (PDF), Transplant Service Documentation Requirements, Trigger Point Injections for Pain Management (PDF), Urinary Incontinence Devices and Treatments (PDF), IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (PDF), Non-myeloablative Allogeneic Stem Cell Transplants (PDF), Physical, Occupation, and Speech Therapy Services, Sclerotherapy and chemical endovenous ablation for Varicose Veins(PDF), Transcatheter Closure of Patent Foramen Ovale (PDF), Behavioral Health Treatment Document Requirement(PDF), Deep Transcranial Magnetic Stimulation for Obsessive Compulsive Disorder (PDF), Substance Use Disorder Treatment and Services (PDF), Biofeedback for Behavioral Health Disorders (PDF), Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (PDF), Adjacent Tissue Transfer Grafts involving Eyelid (PDF), Anterior Segment Photography with FA (PDF), Blepharoplasty, Ptosis and Canthoplasty (PDF), Dark Adaptation and Color Vision Examinations (92283/92284) (PDF), Destruction of a Localized Lesion of the Retina (PDF), Destruction of Localized Lesion of Choroid (PDF), Examination Guidelines for Diabetic Patients (PDF), Indocyanine Green (ICG) Angiography (PDF), Infracture of the Inferior Turbinate (PDF), Laser Iridotomy and Iridectomy for Glaucoma (PDF), Photodynamic and Intravitreal Therapies and Pharmaceuticals (PDF), Probing and Closure of the Lacrimal Duct System (PDF), Surgical Excision of Eyelid Lesions (PDF), Teleretinal Screening for Diabetic Retinopathy (PDF), Ado-Trastuzumab Emtansine (Kadcyla) (PDF), Age Limit Override (Codeine, Tramadol, Hydrocodone) (PDF), Alendronate (Binosto, Fosamax plus D) (PDF), Alpha-1 Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) (PDF), Antithymocyte Globulin (Thymoglobulin, Atgam) (PDF), Anti-Inhibitor Coagulant Complex, Human (Feiba) (PDF), Aprepitant (Emend, Cinvanti), Fosaprepitant (Emend for injection) (PDF), Aripiprazole Long-Acting Injections (Abilify Maintena, Aristada) (PDF), Baclofen (Gablofen, Lioresal, Ozobax) (PDF), Bevacizumab (Avastin, Mvasi, Zirabev) (PDF), Blocking Adjudication of Controlled Substance Prescriptions for Selected Prescribers(PDF), Brand Name Override and Non-Formulary Medications (PDF), Brexucabtagene Autoleucel (Tecartus)(PDF), Brinzolamide/Brimonidine (Simbrinza) (PDF), Budesonide Suspension (Pulmicort Respules) (PDF), Buprenorphine Implant/Injection (Probuphine, Sublocade) (PDF), Buprenorphine-Naloxone (Bunavail, Cassipa, Suboxone) (PDF), C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda) (PDF), C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda, Ruconest) (PDF), Cabozantinib (Cometriq, Cabometyx) (PDF), Ciprofloxacin-Dexamethasone (Ciprodex) (PDF), Ciprofloxacin/Fluocinolone (Otovel) (PDF), Clindamycin Phosphate/Benzoyl Peroxide (BenzaClin) (PDF), Clinical Pharmacy Services Inter-rater Reliability (PDF), Conjugated Estrogens/Bazedoxifene (Duavee) (PDF), Corticosteroid Intravitreal Implants (Iluvien, Ozurdex, Retisert, Yutiq) (PDF), Cysteamine oral (Cystagon, Procysbi) (PDF), Cytomegalovirus Immune Globulin (Cytogam)(PDF), Desmopressin Acetate (DDAVP, Stimate, Noctiva) (PDF), Dextromethorphan-Quinidine (Nuedexta) (PDF), Dimethyl Fumarate (Tecfidera), Diroximel Fumarate (Vumerity) (PDF), Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (PDF), Doxepin (Silenor, Prudoxin, Zonalon) (PDF), Doxycycline Hyclate (Acticlate, Doryx), Doxycycline (Oracea) (PDF), Early and Periodic Screening, Diagnostic, and Treatment Benefit for Pediatric Members (PDF), Elexacaftor/Ivacaftor/Tezacaftor; Ivacaftor (Trikafta) (PDF), Emtricitabine/Tenofovir Alafenamide (Descovy)(PDF), Everolimus (Afinitor, Afinitor Disperz, Zortress) (PDF), Factor IX Complex, Human (Profilnine) (PDF), Factor VIIa, Recombinant (NovoSeven RT) (PDF), Factor VIIa, Recombinant (NovoSeven RT, SevenFact) (PDF), Factor XIII A-Subunit, Recombinant (Tretten) (PDF), Fam-trastuzumab Deruxtecan-nxki (Enhertu) (PDF), Fentanyl IR (Abstral, Actiq, Fentora, Lazanda, Subsys) (PDF), Filagrastim (Neupogen), Filagrastim-sndz (Zarxio), Tbo-filagrastim (Granix) (PDF), Formulary Medications without Specific Guidelines (PDF), Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (PDF), Granisetron (Kytril, Sancuso, Sustol) (PDF), histrelin acetate (Vantas, Supprelin LA) (PDF), Hydroxyprogesterone Caproate (Makena/compound), Indacaterol/Glycopyrrolate (Utibron Neohaler) (PDF), Infertility and Fertility Preservation (PDF), Infliximab (Remicade, Inflectra, Renflexis) (PDF), Insulin Delivery Systems (V-Go, OmniPod, InPen) (PDF), Interferon beta-1b (Betaseron, Extavia) (PDF), Intrathecal Baclofen (Gablofen, Lioresal) (PDF), Isotretinoin (Absorica, Absorica LD, Amnesteem, Claravis, Myorisan, Zenatane) (PDF), Itraconazole (Sporanox, Onmel, Tolsura) (PDF), Lesinurad (Zurampic), Lesinurad/Allopurinol (Duzallo) (PDF), leuprolide acetate (Eligard, Lupaneta Pack, Lupron Depot, Lupron Depot-Ped) (PDF), Levalbuterol (Xopenex HFA/Inhalation Solution) (PDF), Lidocaine Transdermal (Lidoderm, ZTlido) (PDF), Lutetium Lu 177 Dotatate (Lutathera)(PDF), Montelukast oral granules (Singulair) (PDF), Methotrexate (Otrexup, Rasuvo, Xatmep, Reditrex) (PDF), Methoxy polyethylene glycol-epoetin beta (Mircera) (PDF, Methylnaltrexone Bromide (Relistor) (PDF), Minocycline ER (Solodyn, Ximino, Minolira) and Microspheres (Arestin) (PDF), Moxetumomab pasudotox-tdfk (Lumoxiti) (PDF), Multiple Procedure Payment Reduction (MPPR) for Therapeutic Services (PDF), Nadofaragene Firadenovec (Instiladrin) (PDF), Naproxen oral suspension (Naprosyn) (PDF), Neomycin/Fluocinolone Cream (Neo-Synalar)_(PDF), Netarsudil (Rhopressa), Netarsudil/Latanoprost (Rocklatan) (PDF), Netupitant and Palonosetron (Akynzeo), Fosnetupitant and Palonosetron (Akynzeo IV) (PDF), No Coverage Criteria/Off-Label Use Policy (PDF), Non-Formulary and Formulary Contraceptives (PDF), Octreotide (Sandostatin, Sandostatin LAR) (PDF), Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia) (PDF), Olanzapine Long-Acting Injection (Zyprexa Relprevv)(PDF), Onasemnogene Abeparvovec (Zolgensma) (PDF), Paclitaxel, Protein-Bound (Abraxane) (PDF), Peanut Allergen Powder-dnfp (Palforzia) (PDF), Pegaspargase (Oncaspar), Calaspargase pegol-mknl (Asparlas) (PDF), peginterferon alfa-2b (PegIntron, Sylatron) (PDF), Pharmacy and Therapeutics Committee(PDF), Pharmacy Prior Authorization and Medical Necessity Criteria(PDF), Potassium Chloride for Oral Solution (Klor-Con Powder) (PDF), Propranolol HCl Oral Solution (Hemangeol) (PDF), Protein C Concentrate, Human (Ceprotin) (PDF), Repository Corticotropin Injection (H.P.
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