Billing Guidelines for School-Based Services Program
This guide outlines billing guidelines for covered services in the School-Based Services Program, including time increments, delivery types, covered services, and occupational therapy details. Learn about billing time increments, individual vs. group services, and the importance of covered services in Wyoming's SBS.
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Guidelines for Billing Covered Services in the Guidelines for Billing Covered Services in the School School- -Based Services (SBS) Program Based Services (SBS) Program August 23, 2022 1
Guidelines for Billing Guidelines for Billing Time Increments Time Increments and Delivery Type and Delivery Type
Billing Time Increments Billing Time Increments For procedure codes that indicate services are to be billed as 1 unit per 15 minutes or per hour of service, the provider must follow the chart below when the time spent is not exactly 15 minutes or one hour. To receive Medicaid reimbursement, the provider must provide treatment for at least eight minutes. Providers must complete at least eight minutes of treatment be paid for one 15- minutes increment. Time Spent # of 15-minute units to be billed Less than 8 minutes 0 8 minutes to 22 minutes 1 23 minutes to 37 minutes 2 38 minutes to 52 minutes 3 53 minutes to 67 minutes 4 68 minutes to 82 minutes 5 83 minutes to 97 minutes 6 3
Delivery Types: Individual & Group Delivery Types: Individual & Group Services that can be delivered in a group setting: Occupational Therapy Speech Services Physical Therapy Counseling Individual Treatment: one on one treatment. Group Treatment: must include at least two children and no more than five children in order to be billable to Medicaid. Group services are only reimbursable if delivered face-to-face. Telehealth is not an approved modality for group services. Group Service CPT Codes 92508 Short Description Speech/Hearing Therapy, Group; Per session Group Therapeutic Exercises; Per 15 min 97150 H0046 Mental Health Services, Group Therapy; Per 15 min 4
Overview of Overview of Covered Services Covered Services
Covered Services in WY SBS Covered Services in WY SBS Occupational Therapy Nursing Speech Language and Hearing Services Physical Therapy Psychology and Counseling Services Why These Services? These services are most needed and most covered throughout the state. Including these services in the SPA covers a wide range of the services delivered to students in school settings. 6
Occupational Occupational Therapy Therapy
Occupational Therapy: Definition & Occupational Therapy: Definition & Examples Examples Occupational therapy services address the physical, cognitive, psychosocial, sensory, and other aspects of performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. Activities of daily living assessment and training Feeding/oral motor assessment and training; Adaptive equipment application; Sensory integration Musculo-skeletal assessment; Sensorimotor assessment and training Neuromuscular assessment and development Manual therapy techniques; Gross motor assessment and skills facilitation; and Muscle strengthening and endurance training Fine motor assessment and skills facilitation Functional mobility assessment. 8
Occupational Therapy: Providers Occupational Therapy: Providers NPI Provider Title Qualification Licensing Board Supervision required? Taxonomy Needed? Occupational Therapist Wyoming Board of Occupational Therapy Licensed No Yes 225X00000X Yes, must work under the supervision of a licensed occupational therapist. Occupational Therapy Assistant Wyoming Board of Occupational Therapy Licensed No n/a 9
Occupational Therapy: Common Occupational Therapy: Common Services & Codes Services & Codes Occupational Therapy Services CPT Codes 97165 Short Description OT Eval, Low Complex, Per session (typically 30 min) OT Eval, Mod Complex, Per session (typically 45 min) OT Eval, High Complex, Per session (typically 60 min) OT Re-Eval, establish care plan 97166 97167 97168 97110 Therapeutic Exercises; Per 15 min 97150 Group Therapeutic Exercises; Per 15 min 97535 Self-Care/Home Management Training 10
Nursing Nursing
Nursing: Definition & Examples Nursing: Definition & Examples Nursing services are professional services relevant to the medical needs of the patient provided through direct intervention. Nursing/health services are health care services provided to a patient in order to address special healthcare needs/chronic conditions through care management and direct care. Health procedures Direct and indirect patient care services that ensure the safety, comfort, personal hygiene and protection of patients and the performance of disease prevention and restorative measures. IEP/IFSP health assessments Direct and indirect patient services, including, but not limited to the administration of medications and therapeutic agents necessary to implement a treatment, disease prevention or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist. Nutrition assessment Nursing treatments 12
Nursing: Providers Nursing: Providers Provider Title Qualification Licensing Board Supervision required? NPI Needed? Taxonomy Licensed Registered Nurse (RN) Wyoming State Board of Nursing Licensed No Yes 163W00000X Wyoming State Board of Nursing School Nurse RN Licensed No Yes 163WS0200X Licensed Advanced Practice Registered Nurse (APRN) Wyoming State Board of Nursing Licensed No Yes 364SP0808X Yes, must act under the supervision of a physician, RN, or APRN. Licensed Practical Nurse (LPN) Wyoming State Board of Nursing Licensed Yes 164W00000X Yes, must act under the supervision of a physician, RN, or APRN. Wyoming State Board of Nursing School Nurse LPN Licensed Yes 164X00000X Qualified Certified Nurse Assistant Wyoming State Board of Nursing Yes, must work under the direction of a licensed nurse. Certified Yes 376K00000X 13
Nursing: Common Services & Codes Nursing: Common Services & Codes Nursing Services CPT Codes T1001 Short Description Nursing Assessment/Evaluation T1002 RN Services; Per 15 min T1003 LPN/LVN Services; Per 15 min T1004 Certified Nursing Assistant Services; up to 15 min 14
Speech Language Speech Language and Hearing and Hearing Services Services
Speech Language and Hearing Speech Language and Hearing Services: Definition & Examples Services: Definition & Examples Services are provided to improve, develop, or restore functions impaired or lost through illness, injury, or deprivation. Services may include the direct assistance with the selection, acquisition, training or use of an assistive technology device (ATD). Hearing aid evaluation Auditory discrimination in quiet and noise; Impedance audiometry, including tympanometry and acoustic reflex Auditory training Training for the use of augmentative communication devices Central auditory function Testing to determine the child s need for individual amplification; selection and fitting the aid(s) Auditory acuity, speech detection and speech reception threshold 16
Speech Language and Hearing Speech Language and Hearing Services: Providers Services: Providers Provider Title Qualification Licensing Board Supervision required? NPI Needed? Taxonomy Wyoming State Board of Examiners of Speech- Language Pathology and Audiology Wyoming State Board of Examiners of Speech- Language Pathology and Audiology American Speech- Language-Hearing Association Must meet minimum qualifications established by board rule for speech-language pathology aides. Speech-Language Pathologist Licensed No Yes 235Z00000X Licensed Audiologist Licensed No Yes 231H00000X Yes, must work under the direct supervision of a licensed speech-language pathologist. Speech-Language Pathology Assistant Certified No n/a Yes, must work under the direct supervision of a licensed speech-language pathologist. Speech-Language Pathology Aide n/a No n/a 17
Speech Language and Hearing Speech Language and Hearing Services: Common Services & Codes Services: Common Services & Codes Speech Language and Hearing Services CPT Codes 92521 Short Description Evaluation of Speech Fluency 92522 Evaluation of Speech Sound Production 92523 Evaluation of Speech Sound Production; with Evaluation of Language Comprehension and Expression Eval of Oral and Pharyngeal Swallowing Function Speech, Language, Voice, Communication Therapy, Individual Speech, Language, Voice, Communication Therapy, Group Speech/Hearing Therapy, Individual 92610 92507 92508 92507 92508 Speech/Hearing Therapy, Group 18
Physical Therapy Physical Therapy
Physical Therapy: Definition & Physical Therapy: Definition & Examples Examples Physical therapy services are the treatment of physical dysfunction or injury using therapeutic exercise and the application of modalities intended to restore or facilitate normal function or development; also called physiotherapy. Neuromotor assessment Therapeutic procedures Range or motion Manual manipulation Joint integrity and functional mobility Muscle strengthening and therapy techniques Flexibility assessment Gross motor development Gait, balance and coordination assessment and training Functional training Posture and body mechanics assessment and training Sensory motor assessment and training Soft tissue assessment Activities of daily living assessment and training Pain assessment Therapeutic exercise Cranial nerve assessment Adaptive equipment application Nerve conduction Feeding/oral motor assessment and training 20
Physical Therapy: Providers Physical Therapy: Providers Provider Title Qualification Licensing Board Wyoming Board of Physical Therapy Supervision required? NPI Needed? Taxonomy Physical Therapist Licensed No Yes 225100000X Yes, must work under the supervision of a licensed physical therapist. Yes, must work under the supervision of a licensed physical therapist or licensed physical therapist assistant. Physical Therapy Assistant Wyoming Board of Physical Therapy Licensed No n/a Physical Therapy Aide Wyoming Board of Physical Therapy n/a No n/a 21
Physical Therapy: Common Services Physical Therapy: Common Services & Codes & Codes Physical Services CPT Codes 97161 Short Description PT Eval, Low Complex, Per session (typically 20 min) PT Eval, Moderate Complex, Per session (typically 30 min) PT Eval, High Complex, Per session (typically 45 min) PT Re-Eval; Establish Care Plan 97162 97163 97164 97110 Therapeutic Exercises; Per 15 min 97150 Group Therapeutic Exercises; Per 15 min 22
Psychology and Psychology and Counseling Services Counseling Services
Psychology and Counseling Services: Psychology and Counseling Services: Definition & Examples Definition & Examples Mental health services are any interventions- assessment, diagnosis, treatment, or counseling- offered by the LEA for the maintenance or enhancement of mental health or the treatment of mental or behavioral disorders in individual and group contexts. Cognitive assessment Cognitive-behavioral therapy Emotional assessment Individual interactive psychotherapy Behavior assessment Sensory integrative therapy 24
Psychology and Counseling Services: Psychology and Counseling Services: Providers Providers Supervision required? Provider Title Qualification Licensing Board NPI Needed? Taxonomy Licensed Clinical Psychologist Credentialed school psychologist with a Specialist in School Psychology credential Licensed Wyoming Board of Psychology No Yes 103TC0700X Specialist in School Psychology credential and endorsement issued by the Wyoming Professional Teaching Standards Board. Licensed No Yes 103TS0200X Licensed Clinical Social Worker Wyoming Mental Health Professions Licensing Board Licensed No Yes 1041C0700X Must obtain the Professional Services Endorsement for School Social Worker from the Professional Teaching Standards Board. School Social Worker Licensed No Yes 1041S0200X Licensed Marriage and Family Therapist Wyoming Mental Health Professions Licensing Board Licensed No Yes 106H00000X 25
Psychology and Counseling Services: Psychology and Counseling Services: Providers, Continued Providers, Continued Provider Title Qualification Licensing Board Supervision required? NPI Needed? Taxonomy Licensed Professional Counselor Wyoming Mental Health Professions Licensing Board Licensed No Yes 101YP2500X Must obtain the Professional Services Endorsement for School Counselor from the Professional Teaching Standards Board. School Counselor Certification No Yes 101YS0200X Yes, must practice under the supervision of a qualified clinical supervisor licensed in the state of Wyoming. Certified Mental Health Worker Certified by the Wyoming Mental Health Professions Licensing Board Certified Yes 101Y00000X Licensed Behavior Analyst Licensed Behavior Analyst Certification Board No Yes 103K00000X Yes, must provide services under the supervision of a Board Licensed Behavior Analyst. Licensed Assistant Behavior Analyst Licensed Behavior Analyst Certification Board Yes 106E00000X Yes, must provide services under the supervision of a Board Licensed Behavior Analyst or Board Licensed Behavior Analyst Assistant. Registered Behavior Technician Registered Behavior Analyst Certification Board Yes 106S00000X 26
Psychology and Counseling Services: Psychology and Counseling Services: Common Services & Codes Common Services & Codes Psychology and Counseling Services CPT Codes 90791 Psych Diagnostic Evaluation Short Description 90832 Psychotherapy, Individual; Per session (typically 30 min) Psychotherapy, Individual; Per session (typically 45 min) Psychotherapy, Individual; Per session (typically 60 min) Mental Health Services, Group Therapy; Per 15 min Therapeutic Behavioral Services; Per 15 min 90834 90837 H0046 H2019 27
Questions & Resources Questions & Resources https://health.wyo.gov/healthcarefin/medicaid/school-based-services/ Wyoming School-Based Services Website Includes Ressources Such As: Provider Manual Training Documents WY SBS Program Contacts: Justin Browning, WDH, SBS Program Manager justin.browning1@wyo.gov Trent Carroll, WDE, Chief Operations Officer Shelley Hamel, WDE, Chief Academic Officer WYSBS@guidehouse.com 28
