medicaid billing module physical therapy billing form
TRANSCRIPT
Medicaid Billing Module
Physical Therapy
Billing Form
Changes
• Services must be documented on the current IEP for meetings held prior to August 1, 2015.
• Services must be documented on Service Care Plan for IEP meetings held after August 1, 2015.
• As of August 1, 2015 OT specific ICD 10 Diagnosis codes are required.
Physician Authorization
• Physician Authorization is still required annually to bill for physical therapy.
• Authorization can now be from a Physician's Assistant or an Advanced Practice Registered Nurse (APRN).
• Authorization is good for one calendar year from the date signed.
Student Demographics
• Complete this section taking note of the following issues
• The diagnosis code is to be an ICD 10 code that matches the need for physical therapy.
• For provider name print the name of the person providing the service.
Procedure Codes
• Complete beginning and end dates for each procedure.
• List the total number of units for the month for each procedure.
• The form is to be used for only one month.
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 97002 GP 1
Explanation of Procedures and Caps Part 1
97001 GP Physical Therapy Evaluation 1 event per calendar year
97002 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
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
97140 GP Manual therapy techniques (Mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes
20 units per month
97150 GP Therapeutic procedure(s), group (2 or more individuals), 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.
Start and Stop Times
Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15StartTime
End Time
Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31Start Time
End Time
Physical Therapy Assistants (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.
• PTAs cannot 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.• PTA progress/therapy logs are to be co-signed
by the supervising PT for therapy dates that are billed for Medicaid
• There is not a required form for documentation of progress/therapy logs.
Signature and Credentials
• Staff who provided the service will sign the form and list credentials.
• For PTAs, the supervising PT must co-sign the billing form.
Terry Riley – CoordinatorOffice of Special Education
[email protected] ext 53223
WVDE Medicaid Website:http://wvde.state.wv.us/osp/medicaid.html