Apple Health (Medicaid) Provider Alert
An updated School-Based Health Care Services (SBHS) Billing
Guide and SBHS Fee Schedule, effective January 1, 2018, are available on
the SBHS
webpage.
What has changed?
Three new codes have
been added to the SBHS
Billing Guide and
SBHS Fee Schedule. School districts
can begin using the new codes effective January 1, 2018 for date of
service beginning January 1, 2018.
New Therapy Codes
Effective January 1,
2018, the Centers for Medicare and Medicaid Services (CMS) has replaced timed
code 97532 (development of cognitive skills) with untimed code 97127
(therapeutic interventions that focus on cognitive function).
Timed code 97762
(checkout for orthotic/prosthetic use) has been replaced with timed code 97763
(orthotic/prosthetic management and/or training).
Audiologists, occupational
therapists, physical therapists, and speech language
pathologists should review the current 2018 CPT book or the AOTA, APTA, and ASHA websites for assistance with proper use of these codes.
New Behavioral Health Code
Effective January 1,
2018, the following provider types can bill for psychological assessments using
untimed code 90791 (psychological diagnostic evaluation):
- Licensed
psychologist
- Licensed
independent clinical social worker (LiCSW)
- Licensed
advanced social worker (LiACSW)
- Licensed
mental health counselor (LMHC)
Code 96101
(psychological testing by psychologist) is still an approved
code that licensed psychologists may use for psychological
assessments. Mental health providers should review the current 2018 CPT book
for assistance with proper use of these codes.
What else has changed?
Updates to the SBHS
billing guide include general reorganization and
language clarification throughout the guide. Language has been added
in order to clarify the:
- Provider
revalidation process
- IGT
A-19 invoice process
- Referral
process for SBHS services
- Evaluation
and reevaluation reimbursement process
- Billing
process for nursing services provided by noncredentialed staff
- List
of eligible and non-eligible provider types
- SBHS
participation requirements including which entities can contract with
the SBHS program
- Role
of the SBHS coordinator
Questions?
Questions about the
updated SBHS Billing Guide and SBHS Fee Schedule can be directed to the SBHS
program specialist at shanna.muirhead@hca.wa.gov or 360-725-1153.
Thank you!
_______________________________________________________________
The Washington State School-Based Health Care Services (SBHS)
program is administered by the Health Care Authority (HCA). School
districts participating in the SBHS program may receive reimbursement for
providing health care-related services to Medicaid-eligible students with
Individualized Education Programs (IEPs) and Individualized Family Service
Plans (IFSPs). Visit the SBHS
webpage for more information.
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