Chapter 538 School-Based Health Services Occupational Therapy Billing Form Effective August 1, 2019

Consent to Bill Medicaid Prior to billing parents must provide written consent to release information and to bill for Medicaid reimbursement. Consent is valid for one calendar year from the signature date. Parents are to be provided an annual notice.

Plan of Care Services must be documented on the Plan of Care signed by the parent and therapist. Effective August 1, 2019 Service Care Plan is now called a Plan of Care. This provides more consistency and avoids a terminology conflict with private school service plans. There is not a need to have a new one signed if it says Service Care Plan The IEP Program has been adjusted to reflect the change in terminology. 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. All appropriate diagnosis codes need to be listed on the Plan of Care. A global code such as Cerebral Palsy would not be appropriate.

Physician Authorization Form Physician Authorization is required annually to bill for occupational therapy. The Occupational Therapist is to document 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).

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 occupational 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.

Service Record – School Based Occupational Therapy Billing Form Medicaid Number Last Name First Name   WVEIS Number Date of Birth Provider Name County School Month/Year

Service Record – School Based Occupational Therapy Billing Form Medicaid Number Last Name First Name 03900000001  Doe Brody WVEIS Number Date of Birth Provider Name 999999999 9-11-2001 William Dunton Jr County School Month/Year Vandalia  501 Sept/2019

Diagnosis Codes Enter the OT specific ICD 10 Diagnosis Codes on the form starting with box number one. Enter the codes that are directly associated with the therapy sessions and/or assessments.

LIST ALL DIAGNOSIS CODES RELATED TO OCCUPATIONAL THERAPY ICD 10 Diagnosis Codes LIST ALL DIAGNOSIS CODES RELATED TO OCCUPATIONAL THERAPY 1. 2. 3. 4. 5. 6.

LIST ALL DIAGNOSIS CODES RELATED TO OCCUPATIONAL THERAPY ICD 10 Diagnosis Codes LIST ALL DIAGNOSIS CODES RELATED TO OCCUPATIONAL THERAPY 1. R26.9 2. M62.81 3. R27.8 4. 5. 6.

Occupational Therapy Procedure Codes Service Unit 97165 Occupational Therapy Evaluation Low Complexity 1 event per calendar year 97166 Occupational Therapy Evaluation Moderate Complexity 97167 Occupational Therapy Evaluation High Complexity 97168 Occupational Therapy Re-evaluation 2 events per calendar year 97032 GO Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes 20 units per month 97110 GO Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility each 15 minutes 97112 GO Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception for sitting and/or standing activities, each 15 minutes 97113 GO Aquatic Therapy with therapeutic exercises, each 15 minutes 97116 GO Gait training (includes stair climbing) each 15 minutes 97150 GO Therapeutic procedure(s), group (2 or more individuals), each 15 minutes. 97140 GO Manual therapy techniques (mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions each 15 minutes 97530 GO Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance) each 15 minutes 97533 GO 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

Procedure Code Changes Procedure Code 97532 GO is no longer a valid CPT code.

Enter Claim Documentation Use the CPT codes and caps from slide nine to complete the claim documentation section of the billing form. In the first column list the service date. (If combining minutes from different days for a unit use the date the 15th minute occurred to complete the unit. No span dates are allowed.) Column two - enter one or more of the diagnosis code numbers that directly relates to the services. (examples 1, 1 & 3, 2) Column three - enter the CPT code including the GO modifier if appropriate. Columns four and five - enter the start and end time. In the last column enter the total number of units or event(s).

List Diagnosis Code Number(s) Claim Documentation Service Date List Diagnosis Code Number(s) Procedure code   Start Time End Time Units/Event

List Diagnosis Code Number(s) Claim Documentation Service Date List Diagnosis Code Number(s) Procedure code   Start Time End Time Units/Event 9-3-2019 1  97116 GO 9:12 9:37 1  9-6-2019 2,3   97110 GO 1:30  1:45 9-10-2019  9-13-2019  9-17-2019  9-20-2019 2:00 2  9-24-2019  9-27-2019 1,2,3 97168 GO 10:00 11:14

Third Party Billing At times a student may be eligible for Medicaid as the secondary insurance. Medicaid is the payer of last resort for direct services (OT, PT, Speech, Audiology, Psychological, and Nursing). If the student has special transportation services, the direct billing should be submitted. The claim will be denied but will justify claiming transportation billing for that instructional day. Medicaid will pay ancillary services (TCM, personal care aide and special transportation) as the secondary insurance. Occasionally a student may be eligible for Medicaid under two numbers. In this case district’s should always use the primary Medicaid number.

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

Signature and Credentials Staff who provided or directly supervised the service will sign the form and list credentials. For COTAs, the supervising OT must co-sign the billing form and initial specific claims directly supervised. An OT is considered to be directly supervising when in the building at the time of the service. Claims initialed by the OT can be submitted for billing.

Signature and Credentials ____________________ ________________ Signature/Credentials Date   Co-Signature/Credential Date (Initial dates directly supervised)

Signature and Credentials __William Denton Jr.____ OT___ October 1, 2019 Signature/Credentials Date   Co-Signature/Credential Date (Initial dates directly supervised)

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.

Kelley Johnson – Coordinator Office of Special Education kelley Kelley Johnson – Coordinator Office of Special Education kelley.johnson@k12.wv.us 304-558-2696 ext 53539 WVDE Medicaid Website: https://wvde.us/special-education/Medicaid/