Updated SBHS Billing Guide
An updated School-Based Health Care Services (SBHS) Billing Guide, effective January 1, 2019, is available on the SBHS webpage.
What has changed?
An overview of the SBHS Billing Guide updates are outlined below. Contracted school districts can begin using the new codes and the new telemedicine billing instructions for dates of service on or after January 1, 2019.
New speech therapy/audiology code
Effective January 1, 2019, licensed speech language pathologists and licensed audiologists participating in the SBHS program have the option to use speech therapy re-evaluation code S9152 when performing a speech therapy re-evaluation. As always, providers should use their professional judgement to determine the most appropriate code(s) to use for the service(s) provided. S9152 is an untimed code and is billed as one unit no matter how long it takes to perform the service. Per the Centers for Medicare and Medicaid Services (CMS) Medically Unlikely Edits (MUE) rule, the code may be billed once per day, per provider, per student. Speech language pathologists should review the current 2019 CPT book and/or the ASHA website for assistance with proper use of this code.
New psychological evaluation codes
Effective January 1, 2019, the Centers for Medicare and Medicaid Services (CMS) has replaced psychological testing code 96101 with four codes; two codes for Psychological Evaluation Services (96130, 96131) and two for Test Administration and Scoring (96136, 96137). Licensed psychologists participating in the SBHS program should review the current 2019 CPT book, the APA website, and/or the APA Crosswalk for 2019 Psychological Testing and Evaluation CPT Codes for assistance with proper use of the new codes.
Telemedicine
For services provided on or after January 1, 2019, to indicate that the billed service was provided through telemedicine, school districts will submit claims for telemedicine using place of service (POS) 02.
Also effective January 1, 2019, the GT modifier is no longer required on telemedicine claims. However, school districts must enter modifier 95 on any claims for services provided through telemedicine.
School districts should review the Telemedicine section of the SBHS Billing Guide for additional instructions on how to bill for services provided through telemedicine.
What else has changed?
Additional updates to the SBHS Billing Guide include general reorganization and language clarification throughout the guide. Language has been added in order to clarify:
- How school districts submit local match and receive payment from HCA
- Timelines for submitting claims to HCA
- Which providers are eligible to participate in SBHS
- How to confirm a student's Medicaid eligibility
- Directions and resources for new SBHS coordinators
- How to bill for and receive payment for students with private insurance
- How to submit claims to HCA (for self-billing school districts)
- SBHS payments and the SEFA
The SBHS Fee Schedule has been updated to include rates for the five new codes. Rates for all other codes remain the same.
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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