Section 109, Speech and Hearing Services: Rate Changes - Consent Form Required for Sterilizations and Hysterectomies - EVV System Passwords for Personal Care Services and Home Health Care Services

MaineCare Benefits Manual Section 109, Speech and Hearing Services: Rate Changes

Effective May 19, 2019, Chapters II and III, Section 109, Speech and Hearing Services were adopted. Increased reimbursement rates and code additions were adopted with different effective dates as stated below and outlined in Chapter III. You can access the complete rules on the Policy/Rules webpage.

Recently, the Maine State Legislature authorized the Department of Health and Human Services (the Department) to change reimbursement rates in Section 109 that requires an increase to certain agency rates, independent rates, speech-pathology assistant agency rates, and speech-language pathology assistant independent rates. Specifically, the Department increased rates for the following codes effective January 12, 2019: 

• Agency rates for codes 92507 (GN), 92521 (GN), 92522 (GN), 92523 (GN), 92607 (GN), 92608 (GN), 92609 (GN), and 92610.
•  Independent rates for codes 92507 (GN), 92507 (TF, GN), 92508 (HQ, GN), 92508 (TF, HQ, GN), 92521 (GN), 92522 (GN), 92523 (GN), 92524 (GN), 92526 (GN), 92607 (GN), 92608 (GN), 92609 (GN), and 92610. 

Billing Code	Modifier(s)	Description	Agency Rate	Independent Rate
92507	GN	Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual	$53.05	$47.74
92507	TF, GN	Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual intermediate level of care (Assistant)	$44.55	$40.10
92508	HQ, GN	Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals	$19.80	$17.82
92508	TF, HQ, GN	Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals (Assistant)	$19.80	$17.82
92521	GN	Evaluation of speech fluency (eg, stuttering, cluttering)	$76.93	$69.24
92522	GN	Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria)	$62.33	$56.10
92523	GN	Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (eg, receptive and expressive language)	$133.38	$120.04
92524	GN	Behavioral and qualitative analysis of voice and resonance	$64.52	$58.07
92526	GN	Treatment of swallowing dysfunction and/or oral function for feeding	$69.35	$62.42
92607	GN	Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour	$88.11	$79.30
92608	GN	Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure)	$35.36	$31.82
92609	GN	Therapeutic services for the use of speech-generating device, including programming and modification	$73.85	$66.47
92610		Evaluation of oral and pharyngeal swallowing function	$57.79	$52.01

Additionally, the Department made the following changes to the rule effective May 19, 2019:

• Removing the requirement of under age 21 only from codes 92592, 92593, and V5264.
• Adding the following codes:

Billing Code	Description	Agency Rate	Independent Rate
92537	Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)	$27.26	$19.69
92538	Caloric vestibular test with recording, monothermal (ie, one irrigation in each ear for a total of two irrigations)	$13.83	$9.98
92540	Basic vestibular evaluation includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording	$65.87	$47.57
92541	Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording	$36.30	$26.21
92542	Positional nystagmus test, minimum of 4 positions, with recording	$37.56	$27.13
92544	Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording	$30.16	$21.78
92545	Oscillating tracking test, with recording	$28.27	$20.42
92546	Sinusoidal vertical axis rotational testing	$50.53	$36.49
92547	Use of vertical electrodes	$3.00	$2.17
92548	Computerized dynamic posturography	$57.32	$41.40
92570	Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing.	$21.78	$15.73
92611	Motion fluoroscopic evaluation of swallowing function by cine or video recording	$58.89	$53.00
92612	Flexible endoscopic evaluation of swallowing by cine or video recording	$125.93	$113.33
V5011	Fitting/orientation/checking of hearing aid	$56.85	$51.17

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Any claims already submitted at the current or increased rate will be re-processed by the Department and no provider action is required. Claims previously submitted with a new code and denied can now be resubmitted. If a claim needs to be reprocessed with the higher reimbursement rate, please complete the following steps:

1. Log into your Trading Partner Account on the Health PAS Online Portal.
2. Under Form Entry, go to Claim Status.
3. Click on the search icon. Here you may search for affected claims by member, date span, or other identifying factors. Do not attempt to reverse and adjust a DENIED claim.
4. Click on the claim number of the PAID claim you would like to adjust. This will bring up the claim image.
5. Scroll to the bottom of the claim image and click on the option to reverse the claim.
6. Choose the default option (reverse this claim and use the details as a basis for your new claim) for the system to reverse the claim and generate a new claim with the same information.

7. Rate changes effective January 12, 2019 are listed in Table 1. On the new claim, you will need to manually adjust the dollar amount on each service line to reflect the updated rate that is specific to the code you are billing for services. New codes added effective May 19, 2019 are listed in Table 2. They can be billed or rebilled with the effective date of May 19, 2019 and forward. Please see the MaineCare Benefits Manual, Chapter III, Section 109 for the most up-to-date reimbursement rates and effective dates.
8. Adjudicate your claim by scrolling to the bottom and click Adjudicate. This will push the claim through the system edits.
9. Click Save and wait for the dialog box indicating the claim was saved.
10. Click Submit.

We encourage you to adjust your claims in small batches to ensure a timely transaction, as claims may pend for review.

For policy-related questions, please contact Danielle.C.Sack@maine.gov, Provider Relations Specialist, at (207) 624-6950. For questions about the steps to reprocess your claims, please call Provider Services, Monday through Friday, from 7:00 AM to 6:00 PM at 1-866-690-5585 or by email at MaineCareEnroll@molinahealthcare.com. TTY users dial 711.

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Consent Form Required for Sterilizations and Hysterectomies, CR 60661 

 

The issue where some sterilization-related claims did not pend for consent form verification has been corrected. All claims billing services related to the sterilization or hysterectomy must have a consent form attached. These claims will now PEND for validation of an appropriate consent form. If the consent form is missing or invalid the claim will deny. 

 

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Electronic Visit Verification (EVV) System Passwords for Personal Care Services and Home Health Care Services, CR  75606

MaineCare providers who completed the training on how to utilize and manage the EVV software and portal were sent Welcome Kits earlier this year. The temporary passwords included in those kits are about to expire or may already have expired. If your kit contains an expired password, please call the Provider Services Call Center at 1-866-690-5585, Option 3; TTY users dial 711.