Chapter 538 School-Based Health Services

1. Chapter 538 School-Based Health Services Speech Therapy Billing Form

2. Consent to Bill Medicaid • Prior to billing parents must provide written consent to release information and to bill for Medicaid reimbursement. • Consent is valid for one calendar year from the signature date. • Parents are to be provided an annual notice.

3. Plan of Care • Services must be documented on the Plan of Care signed by the parent and therapist. • Effective August 1, 2019 Service Care Plan is now called a Plan of Care. This provides more consistency and avoids a terminology conflict with private school service plans. There is not a need to have a new one signed if it says Service Care Plan and is still current. • The Online IEP Program has been adjusted to reflect the change in terminology. • Specific ICD-10 diagnosis codes are required. ICD-10 codes must relate to the specific type of therapy being provided. Think of these more as treatment diagnosis codes. All appropriate diagnosis codes need to be listed on the Plan of Care. • A global code such as Autism would not be appropriate.

4. Physician Authorization Form • Physician Authorization (PAF) is required annually to bill for speech therapy. • The Speech Therapist is to document suggested ICD-10 diagnosis codes that specifically relate to the therapy being provided. • When the physician signs the authorization form they are confirming the therapist’s code(s). • Authorizations can be signed by a Physician (MD or DO), Physician’s Assistant (PA) or by an Advanced Practice Registered Nurse (APRN). • Should still obtain PAF even if the student will be working with an SSLPA.

5. Student Demographics • Use the student’s real name as listed in WVEIS • The diagnosis code is to be an ICD-10 code that matches the need for speech therapy. • County and school names can be written out or use the county and school WVEIS codes. • For provider name print the name of the person providing the service.

6. Service Record – School Based Speech Therapy Billing Form

7. Service Record – School Based Speech Therapy Billing Form

8. Diagnosis Codes • Enter the Speech/Language specific ICD 10 Diagnosis Codes on the form starting with box number one. • Enter the codes that are directly associated with the therapy sessions and/or assessments.

9. ICD 10 Diagnosis Codes

10. ICD 10 Diagnosis Codes

11. Speech Therapy Procedure Codes

12. Procedure Code Changes • The following is no longer a valid CPT code for billing school-based services in West Virginia. • 92561 – Bekesy Diagnostic • The maximum units of services per month increased from 16 to 24 units for the following CPT codes: • 92507 – Individual therapy • 92508 – Group therapy

13. Enter Claim Documentation • Use the CPT codes and caps from slide eleven to complete the claim documentation section of the billing form. • In the first column list the service date. (If combining minutes from different days for a unit use the date the 15th minute occurred to complete the unit. No span dates are allowed.) • Column two - enter one or more of the diagnosis code numbers that directly relates to the services. (examples 1, 1 & 3, 2) • Column three - enter the CPT code including a GT modifier if being provided by telehealth. • Columns four and five - enter the start and end time. • In the last column enter the total number of units or event(s).

14. Claim Documentation

15. Claim Documentation *Indicates how to document your sessions without a 15 minute unit and bill the unit the day you have the combined 15 minutes.

16. Third Party Billing • At times a student may be eligible for Medicaid as the secondary insurance. • Medicaid is the payer of last resort for direct services (OT, PT, Speech, Audiology, Psychological, and Nursing). • If the student has special transportation services, the direct billing should be submitted. The claim will be denied but will justify claiming transportation billing for that instructional day. • Medicaid will pay ancillary services (TCM, personal care aide and special transportation) as the secondary insurance. • Occasionally a student may be eligible for Medicaid under two numbers. In this case district’s should always use the primary Medicaid number.

17. School Speech-Language Pathologist Assistant (SSLPA) • To bill under BMS policy the speech-language pathologist has to be fully licensed by the West Virginia Board of Examiners for Speech-Language Pathology and Audiology (WVBESLPA). • According to BMS policy a WVDE certified speech-language pathologist is considered an SSLPA. • SLPAs and speech-language pathologists in the CFY year even if licensed by the WVSESLPA are considered SSLPA by BMS policy. • SSLPAs are still to complete the billing paperwork process. However, districts will not submit for direct billing purposes. • SSLPAs can and should submit Targeted Case Management (TCM) billing.

18. Signature and Credentials _____________________ ______________ Signature/Credentials Date

19. Signature and Credentials __Suzanne Smith___ SLP___October 1, 2019 Signature/Credentials Date

20. 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. Please keep a copy of your notes for your personal records. • Lee Ann Brammer in conjunction with BMS has developed a form which can be used to complete the required documentation. It is available on the WVDE website. It is not a mandatory form. • There is not a required form for documentation of progress/therapy logs, however, all of the SOAP (Subjective, Objective, Assessment, and Plan) Note components must be included in the log.

21. Kelley Johnson – CoordinatorOffice of Special Educationkelley.johnson@k12.wv.us304-558-2696 ext 53539WVDE Medicaid Website:https://wvde.us/special-education/Medicaid/