Medicaid Billing Module

1. Medicaid Billing Module Physical Therapy Billing Form

2. Changes • Services must be documented on the current IEP for meetings held prior to August 1, 2015. • Services must be documented on Service Care Plan for IEP meetings held after August 1, 2015. • As of August 1, 2015 OT specific ICD 10 Diagnosis codes are required.

3. Physician Authorization • Physician Authorization is still required annually to bill for physical therapy. • Authorization can now be from a Physician's Assistant or an Advanced Practice Registered Nurse (APRN). • Authorization is good for one calendar year from the date signed.

4. Student Demographics • Complete this section taking note of the following issues • The diagnosis code is to be an ICD 10 code that matches the need for physical therapy. • For provider name print the name of the person providing the service.

5. Procedure Codes • Complete beginning and end dates for each procedure. • List the total number of units for the month for each procedure. • The form is to be used for only one month.

6. Student Demographics and Procedures Sample

7. Explanation of Procedures and Caps Part 1

8. Explanation of Procedures and Caps Part 2

9. Start and Stop Times • Enter the start and stop times for each service on the corresponding date at the bottom of the form. • These will be used to easily identify dates billable services were conducted for students with transportation services.

10. Start and Stop Times

11. Physical Therapy Assistants (PTA) • PTAs can only bill for therapy when a Physical Therapist (PT) certified by the WV Board of Examiners is directly supervising. • Directly supervising requires the Board Certified PT to be on site when the therapy is being provided. • PTAs cannot bill for evaluations.

12. Additional Documentation • Progress/therapy logs will also be required. • Original copies of progress/therapy logs must be on file in the special education central office. • PTA progress/therapy logs are to be co-signed by the supervising PT for therapy dates that are billed for Medicaid • There is not a required form for documentation of progress/therapy logs.

13. Signature and Credentials • Staff who provided the service will sign the form and list credentials. • For PTAs, the supervising PT must co-sign the billing form.

14. Terry Riley – CoordinatorOffice of Special Educationtjriley@k12.wv.us304-957-9833 ext 53223WVDE Medicaid Website:http://wvde.state.wv.us/osp/medicaid.html