MaineCare Benefits Manual, Chapter III, Section 102 - Rehabilitative Services Current Procedural Terminology (CPT) Coding Changes and Prior Authorization (PA) Update

Maine Department of Health & Human Services sent this bulletin at 02/06/2020 05:41 PM EST

Seal Having trouble viewing this email? View it as a Web page.

MaineCare Benefits Manual, Chapter III, Section 102 - Rehabilitative Services Current Procedural Terminology (CPT) Coding Changes and Prior Authorization (PA) Update

CPT Coding Changes

As of January 1, 2020, CPT codes 96150, 96151, 96152, 96153, 96154, and G0515 have been eliminated from billing. The replacement codes are as follows:

Deleted Code	Code Description	Rate	New Code	Code Description	Rate
96150 96151	Clinical Assessment-Initial Clinical Reassessment	20.64 20.64	96156	Health behavior assessment or reassessment – includes health-focused clinical interviews, behavioral observations, and clinical decision making	20.64
G0515 ST	Intensive Integrated Neurorehabilitation	26.02	97129 ST	Therapeutic interventions that focus on cognitive function (e.g. attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g. managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes	26.02
G0515 ST	Intensive Integrated Neurorehabilitation	26.02	97130 ST	Add on code: each additional 15 minutes	26.02
96152	Neurobehavioral Rehab - 1:1	20.98	96158	Health behavior intervention, individual, face-to-face; initial 30 minutes	41.96
96152	Neurobehavioral Rehab - 1:1	20.98	96159	Health behavior intervention, individual, face-to-face; each additional 15 minutes	20.98
96153	Neurobehavioral Rehab - group	20.91	96164	Health behavior intervention, group, face-to-face; initial 30 minutes	41.82
96153	Neurobehavioral Rehab - group	20.91	96165	Health behavior intervention, group; face-to-face; each additional 15 minutes	20.91
96154	Neurobehavioral Rehab - family	20.07	96167	Health behavior intervention, family, face-to-face; initial 30 minutes	40.14
96154	Neurobehavioral Rehab - family	20.07	96168	Health behavior intervention, family; face-to-face; each additional 15 minutes	20.07

Please note that 96150 and 96151 have been consolidated into a single code, 96156, used for either clinical assessment or reassessment. Providers should continue to bill in accordance with policy Section 102.05-1.

For any questions regarding this coding update, please contact Tammy Usher, Provider Relations Specialist, by email at Tammy.L.Usher@maine.gov or phone at (207) 624-6933.

Prior Authorization (PA) Update

Additionally, the Office of Aging and Disability Services (OADS) is working to revise the PA documents used to request services. This will allow providers to request services that started on or after January 1, 2020. Any services that were approved prior to January 1, 2020, will automatically be reassigned a new PA with the new CPT codes.

For any questions regarding PA documents, please contact Esther Hunt at (207) 744-1219.

Update your subscriptions, modify your password or email address, or stop subscriptions at any time on your Subscriber Preferences Page. You will need to use your email address to log in. If you have questions or problems with the subscription service, please visit subscriberhelp.govdelivery.com.

This service is provided to you at no charge by Maine Department of Health & Human Services.