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Medicaid Procedure Code Changes: Effective August 1, 2019

Stay informed about the latest Medicaid procedure code changes, including telehealth availability, new psychological testing codes, increased unit allowances, and billing guidelines. Make sure to use the GT modifier for telehealth services.

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Medicaid Procedure Code Changes: Effective August 1, 2019

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  1. Chapter 538 School- Based Health Services Psychological Services

  2. Medicaid procedure code changes Effective August 1, 2019 • 90791 – Telehealth is now available for this code. Must use a GT modifier when billing, if telehealth was used. • 96101 was replaced The new codes are : 96130, 96131, 96136, and 96137 • 96130 Psychological testing – 2 units per calendar year, 60- minute unit • 96131 Psychological Testing; additional hour – 4 units per calendar year, 60- minute units. * Can only be used if billed with 96130* • 96136 Test Administration and scoring - 1 unit per calendar year, 30- minute units. • 96137 Test Administration and scoring; additional 30 minutes- 4 units per calendar year, 30-minute units.

  3. Medicaid procedure code changes continued • Example of how the new codes could be used: • 96130 - 1 unit (60 minutes) • 96131 - 2 units (120 minutes) • 96136 - 1 unit (30 minutes, can only use once, 1 unit max) • 96137 - 2 units (60 minutes) • However this is ONLY a suggestion. If you need more time on 96130 or 96131, the units are there to use. Also if additional time was used on scoring, 96137 has a max of 4 units.

  4. Medicaid procedure code changes continued • 90832 Units increased to 20 per calendar year • 90834 Units increased to 20 per calendar year • 90837 units increased to 20 per calendar year • 90846 units increased to 20 per calendar year • 90847 units increased to 20 per calendar year • 90853 units increased to 20 per calendar year • All of these codes are also available as Telehealth. If billing telehealth, you must use the GT modifier on your billing to signify it was completed via telehealth.

  5. Billing Form

  6. Billing Form

  7. Diagnosis Codes • Enter the Psychological 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.

  8. ICD 10 Diagnosis Codes

  9. ICD 10 Diagnosis Codes

  10. School Based Psychological Services Procedure codes

  11. Enter Claim Documentation • Use the procedure codes and caps 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).

  12. Claim Documentation

  13. Claim Documentation

  14. Signature and Credentials _____________________ ______________ Signature/Credentials Date

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

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