School-Based Speech Therapy Billing Guidelines 2019

Cha p ter 5 38 Sc ho o l - Ba sed Hea l th Servi c es Speech Therapy Billing Form Effective August 1, 2019

Co nsent to Bi l l M edi c a i d 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. 2

P l a n o f Ca re 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 and is still current. The Online 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 Autism would not be appropriate. 3

P hysi c i a n Autho ri za ti o n F o rm Physician Authorization (PAF) is required annually to bill for speech therapy. The Speech 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). Should still obtain PAF even if the student will be working with an SSLPA. 4

Student Dem o gra p hi c s 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 speech 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

Servi c e Rec o rd Servi c e Rec o rd Sc ho o l Based Sp eec h Therap y Sc ho o l Based Sp eec h Therap y Bi l l i ng F o rm Bi l l i ng F o rm Medicaid Number Last Name First Name WVEIS Number Date of Birth Provider Name County School Month/Year 6

Servi c e Rec o rd Servi c e Rec o rd Sc ho o l Based Sp eec h Therap y Sc ho o l Based Sp eec h Therap y Bi l l i ng F o rm Bi l l i ng F o rm Medicaid Number Last Name First Name 03900000003 Doe Aubrey WVEIS Number Date of Birth Provider Name Suzanne Smith 999999999 3-8-2008 County School Month/Year 59 501 Sept/2019 7

Di a gno si s Co des Enter the Speech/Language 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. 8

I CD 10 Di a gno si s Co des LIST ALL DIAGNOSIS CODES RELATED TO SPEECH THERAPY 1. 2. 3. 4. 5. 6. 9

I CD 10 Di a gno si s Co des LIST ALL DIAGNOSIS CODES RELATED TO SPEECH THERAPY 1. F80.0 2. F80.2 3. F80.81 4. F80.82 5. 6. 10

Sp eec h Thera p y P ro c edure Co des Code Procedure Service Unit Treatment of speech language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); Individual therapy session Treatment of speech language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); Group, two or more individuals 24 units per month at 15 minutes per unit 24 units per month at 15 minutes per unit 92507 92508 92521 Evaluation of speech fluency (e.g., stuttering, cluttering) 1 per calendar year Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) Evaluation of speech production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) 92522* 1 per calendar year 92523* 1 per calendar year 92524 Behavioral and qualitative analysis of voice and resonance 1 per calendar year 92567 92570 92583 92592 92593 Tympanometry (impedance testing) Can also be performed by RN Acoustic Immitance Testing Can also be performed by RN Select Picture Audiometry Hearing Aid Check - Monaural Hearing Aid Check-Binaural Notes: *92522 and 92523 may not be billed together on the same day. A speech sound production evaluation (92522) is already included as a part of 92523 (speech sound production evaluation with language evaluation). If a service is provided via Telehealth add GT modifier to the procedure code. 1 per calendar year 4 per calendar year 1 per calendar year 4 per calendar year 4 per calendar year 11

P ro c edure Co de Cha nges The following is no longer a valid CPT code for billing school-based services in West Virginia. 92561 Bekesy Diagnostic The maximum units of services per month increased from 16 to 24 units for the following CPT codes: 92507 Individual therapy 92508 Group therapy 12

E nter Cl a i m Do c um enta ti o n Use the CPT codes and caps from slide eleven 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 a GT modifier if being provided by telehealth. Columns four and five - enter the start and end time. In the last column enter the total number of units or event(s). 13

Cl a i m Do c um enta ti o n Service Date List Diagnosis Code Number(s) Procedure code Start Time End Time Units/Event 14

Cl a i m Do c um enta ti o n Service Date List Diagnosis Code Number(s) Procedure code Start Time End Time Units/Event 9-4-2019 9-5-2019 9-9-2019 9-10-2019 9-12-2019 9-16-2019 1 1 3 1 2,4 92507 92507 92508 92507 92507 92521 9:00 9:00 10:31 9:00 1:00 8:30 9:10 9:10 11:01 9:10 1:40 10:15 0* 1* 2 1* 2 1 1,2,3,4 *Indicates how to document your sessions without a 15 minute unit and bill the unit the day you have the combined 15 minutes. 15

Thi rd P a rty Bi l l i ng 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. 16

Sc ho o l Sp eec h- La ngua ge P a tho l o gi st Assi sta nt ( SSLP A) To bill under BMS policy the speech-language pathologist has to be fully licensed by the West Virginia Board of Examiners for Speech-Language Pathology and Audiology (WVBESLPA). According to BMS policy a WVDE certified speech-language pathologist is considered an SSLPA. SLPAs and speech-language pathologists in the CFY year even if licensed by the WVSESLPA are considered SSLPA by BMS policy. SSLPAs are still to complete the billing paperwork process. However, districts will not submit for direct billing purposes. SSLPAs can and should submit Targeted Case Management (TCM) billing.

Si gna ture a nd Credenti a l s _____________________ Signature/Credentials Date ______________ 18

Si gna ture a nd Credenti a l s __Suzanne Smith___ SLP___ Signature/Credentials October 1, 2019 Date 19

Addi ti o na l Do c um enta ti o n Progress/therapy logs will also be required. Original copies of progress/therapy logs must be on file in the special education central office. Please keep a copy of your notes for your personal records. Lee Ann Brammer in conjunction with BMS has developed a form which can be used to complete the required documentation. It is available on the WVDE website. It is not a mandatory form. There is not a required form for documentation of progress/therapy logs, however, all of the SOAP (Subjective, Objective, Assessment, and Plan) Note components must be included in the log.

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