Babies Can't Wait early intervention services procedure codes, service limits and rates [2011]

BABIES INFORMATION AND BILLING SYSTEM
Early Intervention Service
Procedure Codes, Limits and Rates
Georgia Department of Public Health Office of Maternal and Child Health Children and Youth with Special Needs Unit

Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates INTRODUCTION Babies Can't Wait (BCW) is Georgia's comprehensive, coordinated, statewide, interagency service delivery system for infants and toddlers, birth to three years of age, who have developmental delays, and their families. The program is established under Part C of the Individuals with Disabilities Education Act (IDEA), as amended. Babies Can't Wait early intervention services are to be family-centered, provided in natural environments and culturally competent. The purpose of this document is to define the authorized providers, settings and rates for Part C early intervention services in Georgia. Although service settings for natural and non-natural environments are listed below, please be advised it is essential that children should be receiving services in the natural environment. Non-natural service settings should be used only when necessary to appropriately deliver the related service.
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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates
BABIES CAN'T WAIT EARLY INTERVENTION SERVICES TABLE OF CONTENTS

Assistive Technology Devices

3.

Audiology Services

3.

Family, Training, Counseling and Home Visits

4.

Health Services

5.

Medical Services

6.

Nursing Services

6.

Nutrition Services

7.

Occupational Therapy

8.

Physical Therapy

9.

Psychological Services

11.

Service Coordination

12.

Social Work Services

12.

Special Instruction

13.

Speech-Language Pathology

14.

Vision Services

16.

Other Related Services

17.

Appendix A: CPT Modifier Descriptions

18.

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

ASSISTIVE TECHNOLOGY
The IDEA definition of assistive technology devices is broad and covers a wide range of technology devices. Assistive Technology for children with disabilities may include any of the following: 1. augmentative communication devices (i.e. single or multiple message devices with speech or picture output); 2. vision and hearing devices (i.e. magnifying glasses, backlit surfaces, amplification systems, and tape recorders) Does not include a medical device that is surgically implanted, or the replacement of such device. ( 34CFR 300.5); 3. mobility and positioning equipment (i.e. supports for seating, adapted tricycles/scooters, etc); 4. appliance control devices (i.e. electrical control units for switch activation. Note: In catalogs these devices are also referenced as "environmental control units"); 5. learning tools (i.e. built-up writing instruments, knobbed puzzles); 6. adaptive daily living tools (i.e. built-up spoons, bath supports); and 7. adaptive toys (i.e. switch activation, built-up handles, amplified sounds or actions).

ASSISTIVE TECHNOLOGY DEVICE
Device* Device Rental borrowed from District BCW Office

PROCEDURE CODE

SERVICE LIMIT
NA NA

BCW RATE $0

* To purchase a device that is over $1000.00, approval from the state office must be received.

AUDIOLOGY SERVICES
Audiology includes 1) identification of children with auditory impairment, using at-risk criteria and appropriate audiologic screening techniques; 2) determination of the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures; 3) referral for medical and other services necessary for the habilitation or rehabilitation of children with auditory impairment; 4) provision of auditory training, aural rehabilitation, speech reading, and listening device orientation and training, and other services; 5) provision of services for prevention of hearing loss; and 6) determination of the child's need for individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices. (Title 34 CFR 303.12(d)(2))

AUTHORIZED SETTING: Clinic or Hospital AUTHORIZED PROVIDER: Licensed Audiologist AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING AUDIOLOGY SERVICES:

AUDIOLOGY SERVICES Aural rehabilitation Pure tone audiometry (threshold); air only.

PROCEDURE CODES 92507
92552

MODIFIERS UC HA HA

SERVICE LIMITS 8 units per month; 1 unit per visit
2 units per year;

BCW RATE $62.53
$15.63

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

Speech audiometry; threshold only.

92555

Basic comprehensive audiometry (Pure tone, air and bone, and speech, threshold and discrimination). Tympanometry (impedance testing) Acoustic reflex testing.

92557
92567 92568

Conditioning play audiometry.

92582

Brainstem evoked response recording (evoked response (EEG) audiometry). Auditory evoked potentials for comprehensive evoked response audiometry and/or testing of the central nervous system.
Diagnostic analysis of cochlear implant, patient under 7 yrs. of age with programming.

92585 92601

Diagnostic analysis of cochlear implant, patient 92602 under 7 yrs. of age, subsequent re-programming.

Evoked Otoacoustic Emissions, Limited (OAE).

92587

Evoked Otoacoustic Emissions. Comprehensive or diagnostic evaluation (comparison of transient and/or distortion product of otoacoustic emissions at multiple levels and frequencies). Visual Reinforcement Audiometry Auditory evoked for evoked response audiometry and/or testing of the central nervous system; limited (AABR). Hearing Aid Check

92588
92579 92586 99212

Coaching Visit IFSP Development/ Meeting (for multi- disciplinary team)

HA HA
UC HA HA HA HA

1 unit per visit 2 units per year 1 unit per visit 2 units per year 1 unit per visit
4 units per year 2 units per year 1 unit per visit 2 units per year 1 unit per visit 2 units per year; 1 unit per visit

$13.38 $42.04
$18.46 $13.38 $25.19 $109.76

UC HA UC HA
HA HA
HA HA HA

Limited to 1 unit per calendar year.

$116.23

Limited to 7 units per calendar year. 1 unit = 1 visit.
3 units per year 1 unit per visit 3 units per year 1 unit per visit

$81.09
$52.51 $70.52

4 units per year 2 units per year 1 unit per visit

$25.19 $65.99

2 units per year 1 unit per visit 1 unit per visit 1 unit = 1 visit 1 visit is greater than or equal to 30 minutes.

$25.12
$60.00 $40

FAMILY, TRAINING, COUNSELING AND HOME SERVICES
Family Training, Counseling and Home Visits means services provided, as appropriate by social workers, psychologists, licensed professional counselors, licensed clinical social workers and other qualified personnel, to assist the family of a child eligible under this part in understanding the special needs of the child and enhancing the child's development. (34 CFR 303.12(d)(3))

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility AUTHORIZED PROVIDER: Licensed Health Care Provider * Providers must maintain a contract with BCW to provide these services. AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING COUNSELING SERVICES:

FAMILY, TRAINING, COUNSELING AND HOME VISITING SERVICES
Evaluation

PROCEDURE CODE
96150

MODIFIER HA

Services Family training and counseling for child development, (onsite or offsite)

96151

HA, TS

IFSP Development/ Meeting (for multi-disciplinary team)
Excessive Travel 45-65 miles Excessive Travel 66-85 miles Excessive Travel 86-100+ miles

SERVICE LIMITS
Limited to 1 per year, 1 visit = 3 units. Limited to the maximum allowable of 3 units billed per visit. Limited to 5 visits per year. One (1) visit per month. One visit =2 units. Limited to he maximum allowable of 2 units billed per visit. 1 unit = 1 visit 1 visit is greater than or equal to 30 minutes. 1 visit = 1 unit.
1 visit = 1 unit.
1 visit = 1 unit.

BCW RATE $24.80
$24.19
$40.00 $30.00 $35.00 $40.00

HEALTH SERVICES
Health Services means services necessary to enable a child to benefit from the other early intervention services under this part during the time that the child is receiving the other early intervention services. (Title 34 CFR 303.13(a))
AUTHORIZED SETTING: Clinic, Hospital, Residential Facility, Special Purpose Facility AUTHORIZED PROVIDER: Licensed Physician, Licensed Nurse Practicioner AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING HEALTH SERVICES:

HEALTH SERVICES Office or other outpatient visit Office or other outpatient visit

PROCEDURE CODE 99212
99213

SERVICE LIMITS
1 unit = 10 minutes/visit 1 unit = 15 minutes/visit

BCW RATE $29.67 $40.70

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

Office or other outpatient visit
Office or other outpatient visit
IFSP Development/ Meeting (for multi-disciplinary team)

99214 99215

1 unit = 25 minutes/visit 1 unit = 40 minutes/visit 1 unit = 1 visit 1 visit is greater than or equal to 30 minutes.

$62.71 $93.46 $40.00

MEDICAL SERVICES
Medical Services only for diagnostic or evaluation purposes means services provided by a licensed physician to determine a child's developmental status and need for early intervention services. (Title 34 CFR 303.12(d)(5))

AUTHORIZED SETTING: Clinic, Hospital, Residential Facility, Special Purpose Facility AUTHORIZED PROVIDER: Licensed Physician, Licensed Nurse Practitioner AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING MEDICAL SERVICES:

MEDICAL SERVICES
Office consultation, new or existing patient, minor severity Office consultation, new or existing patient, low severity Office consultation, new or existing patient, moderate severity Office consultation, new or existing patient, moderate to high severity Office consultation, new or existing patient, moderate to high severity IFSP Development/ Meeting (for multi-disciplinary team)

PROCEDURE CODE 99241
99242
99243
99244
99245

SERVICE LIMITS
1 unit = 15 minutes/visit 1 unit = 30 minutes/visit 1 unit = 40 minutes/visit 1 unit = 60 minutes/visit 1 unit = 80 minutes/visit 1 unit = 1 visit 1 visit is greater than or equal to 30 minutes.

BCW RATE $48.05 $78.78 $100.50 $139.12 $180.61 $40.00

NURSING SERVICES
Nursing services include the assessment of health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems; provision of nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development; and administration of medications, treatments, and regimens prescribed by a licensed physician. (Title 34 CFR 303.12(d)(6))

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

AUTHORIZED SETTING: Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Licensed Registered Nurse AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING NURSING SERVICES:

NURSING SERVICES
Nursing Medication Administration - Limited to 8 units per calendar month. 1 unit = 15 minutes; may bill up to 4 units per day. Nursing Treatment includes assessments and teaching related to treatment.

PROCEDURE CODE T1502
T1002

IFSP Development/ Meeting (for multi- disciplinary team). Limited to 8 units per calendar month. 1 unit = 15 minutes.

MODIFIER HA TD

SERVICE LIMITS

BCW RATE $7.78

HA

1 unit = 15

minutes/visit

$7.78

1 unit = 1 visit

$40.00

1 visit is greater than or

equal to 30 minutes.

NUTRITION SERVICES
Nutrition Services includes conducting individual assessments in nutritional history and dietary intake, anthropometric, biochemical, and clinical variables; feeding skills and feeding problems; and food habits and food preferences. (Title 34 CFR 303.12(d)(7))

AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Licensed Dietitian AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING NUTRITION SERVICES:

NUTRITION SERVICES Nutrition Evaluation
Nutrition Services
Coaching Visit IFSP Development/ Meeting (for multi-disciplinary team)

PROCEDURE CODE
97802

MODIFIER HA

97803

HA, TS

SERVICE LIMIT

BCW RATE

Limited to one evaluation per year. 1 visit = 3 units.
Limited to 9 visits per year, limited to one (1) per month. 1 visit = 1 unit.
1 visit = 1 unit.
1 unit = 1 visit 1 visit is greater than or equal to 30 minutes.

$20.00 $16.67
$50.00 $40.00

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

Excessive Travel 45-65 miles Excessive Travel 66-85 miles Excessive Travel 86-100+ miles

1 visit = 1 unit. 1 visit = 1 unit. 1 visit = 1 unit.

$30.00 $35.00 $40.00

OCCUPATIONAL THERAPY
Occupational Therapy includes services to address the functional needs of a child related to adaptive development, adaptive behavior, and play, and sensory, motor, and postural development. These services are designed to improve the child's functional ability to perform tasks in home, school, and community settings. Title CFR 303.12(d)(8)

AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Licensed Occupational Therapist AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING OCCUPATIONAL THERAPY:

OCCUPATIONAL THERAPY SERVICES
Evaluation Re-evaluation
Orthotic(s) Management and training (including assessment and fitting when not otherwise reported). Upper extremity(s), Lower Extremity (s) and/or trunk, each 15 minutes. Limited to 8 units per calendar month. 1 unit = 15 minutes Prosthetic training, upper and/or lower extremity(s), each 15 minutes. 1 unit = 15 minutes.
Therapeutic activities, Direct (one-on-one) member contact by the provider (use of dynamic activities to improve functional performance); 1 unit = 15 minutes Self care/home management training (e.g. activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment) direct one-on-one contact by provider; 1 unit = 15 minutes Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) member contact by the provider, 1 unit = 15 minutes Community/work reintegration training (e.g. shopping, transportation, money management, avocational activities and/or

PROCEDURE CODES 97003 97004 97760
97761
97530
97535
97533
97537

MODIFIERS HA HA HA
GOHA GO HA
HA
GO HA
HA

SERVICE LIMITS
1 per year 1 every 180 days Limited to 8 units per calendar month or combination of 8 units per calendar month.
Limited to 8 units per calendar month or combination of 8 units per calendar month. 8 units per calendar month or combination of 8 units per calendar month 8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar

BCW RATE $60.00 $30.00 $29.38
$26.98 $21.76 $23.67
$26.46
$23.37

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

work environment/modification analysis, work task analysis). Direct one on one contact by the provider; 1 unit = 15minutes
Aquatic therapy with therapeutic exercises; 1 unit = 15 minutes

97113

Manual therapy techniques (e.g. mobilization/ manipulation manual traction) one or more regions; 1 unit = 15 minutes Wheelchair management/ prosthetic use, established member 1 unit = 15 minutes
Checkout for ortho/prosthetic use, established patient, each 15 minutes, 1 unit = 15 minutes
Physical performance test or measurement (e.g. musculoskeletal, functional capacity) with written report; 1 unit = 15 minutes
Coaching Visit
IFSP Development/ Meeting (for multi- disciplinary team)
Excessive Travel 45-65 miles
Excessive Travel 66-85 miles
Excessive Travel 86-100+ miles

97140 97542 97762 97750

month

GO HA GO HA GO HA GO HA GO HA

8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
1 visit = 1 unit.

$24.32 $24.97 $16.82 $25.39 $24.31 $60.00

1 unit = 1 visit 1 visit is greater than or equal to 30 minutes.
1 visit = 1 unit.

$40.00 $30.00

1 visit = 1 unit.

$35.00

1 visit = 1 unit.

$40.00

PHYSICAL THERAPY
Physical Therapy includes services to address the promotion of sensorimotor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual, and motor development, cardiopulmonary status, and effective environmental adaptation. (Title 34 CFR 303.12(d)(9))

AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Licensed Physical Therapist AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING PHYSICAL THERAPY:

PHYSICAL THERAPY SERVICES

PROCEDURE

MODIFIERS SERVICE

BCW RATE

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

Evaluation - Limit 1 evaluation per calendar year Re-evaluation - Limit 1 reevaluation every 180 days Therapeutic procedure, one or more areas, therapeutic exercises to develop strength and endurance, range of motion and flexibility; 1 unit = 15 minutes Neuromuscular reeducation of movement, balance, coordination, kinesthetic senses, posture and proprioception; 1 unit = 15 minutes
Aquatic therapy with therapeutic exercises; 1 unit = 15 minutes

CODES 97001 97002 97110
97112
97113

Gait training (includes stair climbing) 1 97116 unit = 15 minutes

Prosthetic training, upper and/or

97761

lower extremity(s), each 15 minutes.

Application of a modality to one or more areas; electrical stimulation (manual); 1 unit = 15 minutes
Ultrasound, 1 unit = 15 minutes

97032 97035

Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion); 1 unit = 15
Whirlpool, 1 unit = 15 minutes

97124 97022

Therapeutic activities, direct (one-on- 97530 one) member contact by the provider

HA HA HA HA GP HA HA GP HA HA HA HA HA GP HA

LIMITS 1 per year

$60.00

1 every 180 days

$30.00

8 units per calendar month or combination of 8units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or combination of 8 units per calendar
8 units per calendar month or combination of 8 units per calendar month
8 units per calendar month or

$22.07 $23.03 $24.32 $20.85 $26.98 $16.50 $12.69 $19.29 $14.97 $21.76

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

(use of dynamic activities to improve functional performance) 1 unit = 15 minutes
Wheelchair management/prosthetic use established member 1 unit = 15 minutes

97542

Diathermy, 1 unit = 15 minutes

97024

Manual therapy techniques (e.g. mobilization/manipulation, manual traction) one or more regions 1 unit = 15 minutes
Checkout for ortho/prosthetic use, established patient each 15 minutes. 1 unit = 15 minutes
Physical performance test or measurement (e.g., musculoskeletal, functional capacity) with written report . 1 unit = 15 minutes
Coaching Visit

97140 97762 97750

IFSP Development/ Meeting (for multi-disciplinary team)

Excessive Travel 45-65 Miles Excessive Travel 66-85 Miles Excessive Travel 86-100 Miles

T2003 T2003 T2003

GP HA HA GP HA GP HA GP HA

combination of 8 units per calendar

8 units per calendar $16.82 month or combination of 8 units per calendar
8 units per calendar $11.22 month or combination of 8 units per calendar
8 units per calendar $24.97 month or combination of 8 units per calendar

8 units per calendar $25.39 month or combination of 8 units per calendar
8 units per calendar $24.31 month or combination of 8 units per calendar

$60.00

1 unit = 1 visit 1 visit is greater than or equal to 30 minutes.

$40.00 $30.00

$35.00 $40.00

PSYCHOLOGICAL SERVICES
Administering psychological and developmental tests and other assessment procedures; interpreting assessment results; obtaining, integrating, and interpreting information about child behavior, and child and family conditions related to learning, mental health, and development; and planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development, parent training, and education programs. (Title 34 CFR 303.12(d)(10))
AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Licensed Psychologist AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING PSYCHOLOGICAL SERVICES:
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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

PSYCHOLOGICAL SERVICES
Evaluation Services
IFSP Development/ Meeting (for multi-disciplinary team)

PROCEDURE CODE
96101 90801 90806

MODIFIER
HA HA, TS

Excessive Travel 45-65 Miles Excessive Travel 66-85 Miles Excessive Travel 86-100 Miles

T2003 T2003 T2003

SERVICE LIMIT

BCW RATE

1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1 unit = 1 visit 1 visit is greater than or equal to 30 minutes. 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit

403.40 $115.00 $115.00 $40.00
$30.00 $35.00 $40.00

SERVICE COORDINATION (CASE MANAGEMENT)

Service coordination services means assistance and services provided by a service coordinator to a child eligible under this part and the child's family that are in addition to the functions and activities included under Sec. 303.23. (Title 34 CFR 303.12(d)(11))

AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Intake Coordinator or Service Coordinator AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING CASE MANAGEMENT SERVICES:

CASE MANAGEMENT SERVICES
IFSP Development/ Meeting (for multi-disciplinary team) Intake Coordination Face-To-Face Visit Excessive Travel 45-65 Miles Excessive Travel 66-85 Miles Excessive Travel 86-100 Miles

PROCEDURE CODE T2003
T2003 T2022 T2003 T2003 T2003

MODIFIER

SERVICE LIMIT
1unit = 1 visit
1unit = 1 visit
1unit = 1 visit 1unit = 1 visit 1unit = 1 visit

BCW RATE
$70.00
$70.00 $140.00 $30.00 $35.00 $40.00

SOCIAL WORK SERVICES
Social Work services include making home visits to evaluate a child's living conditions and patterns of parent-child interaction; preparing a social or emotional developmental assessment of the child within the family context; providing individual and family-group counseling with parents and other family members, and appropriate social skill-building activities with the child and parents; working with those problems in a child's and family's living situation (home, community, and any center where early
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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

intervention services are provided) that affect the child's maximum utilization of early intervention services; and identifying, mobilizing, and coordinating community resources and services to enable the child and family to receive maximum benefit from early intervention services. (Title 34 CFR 303.12(d)(12))

AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Licensed Clinical Social Worker AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING SOCIAL WORK SERVICES:

SOCIAL WORK SERVICES
Evaluation/assessment (onsite or offsite) IFSP Development/ Meeting (for multi-disciplinary team)

PROCEDURE CODE
90802

MODIFIER

SERVICE LIMIT

BCW RATE

1unit = 1 visit $118.31

1 unit = 1 visit 1 visit is greater than or equal to 30 minutes.

$40.00

SPECIAL INSTRUCTION
The design of learning environments and activities that promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction; curriculum planning, including the planned interaction of personnel, materials, and time and space, that leads to achieving the outcomes in the child's individualized family service plan; providing families with information, skills, and support related to enhancing the skill development of the child; and working with the child to enhance the child's development. (Title 34 CFR 303.12 (d)(13))
AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Early Intervention Specialist, Early Interventionist, Early Intervention Assistant AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING SPECIAL INSTRUCTION SERVICES:

SPECIAL INSTRUCTION Initial Evaluation Service
Coaching Visit

PROCEDURE CODE
T2003

MODIFIER

T2003

T2022

SERVICE LIMIT
1unit = 1 visit
1unit = 15 minutes
1 unit = 15 minutes

BCW RATE
$60.00 $60.00 $10.00* $ 8.75** $ 7.50*** $10.00* $ 8.75**

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

IFSP Development/ Meeting (for multi-disciplinary team)

Excessive Travel 45-65 Miles

T2003

Excessive Travel 66-85 Miles

T2003

Excessive Travel 86-100 Miles T2003

* Rate for Early Intervention Specialist

** Rate for Early Interventionist

*** Rate for Early Intervention Assistant

1 unit = 1 visit 1 visit is greater than or equal to 30 minutes. 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit

$ 7.50*** $40.00
$30.00 $35.00 $40.00

SPEECH-LANGUAGE PATHOLOGY SERVICES
Identification of children with communicative or orophyaryngeal disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills; referral for medical or other professional services necessary for the habilitation or rehabilitation of children with communicative or oropharyngeal disorders and delays in development of communication skills; and provision of services for the habilitation, rehabilitation or prevention of communicative or oropharyngeal disorders and delays in development of communication skills. (Title 34 CFR 303.12(d)(14))

AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Speech-Language Pathologist, CFY - Speech-Language Pathologist AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING SPEECH-LANGUAGE PATHOLOGY THERAPY:

Speech Therapy Services:
Evaluation of speech language, voice, and language communication, auditory processing, and/or aural rehabilitation status limited to 2 per calendar year. 1 unit = 1 visit; therefore, may only bill 1 unit per visit Speech Language Therapy, (includes aural rehabilitation); individual treatment of speech, language, voice, communication, and/or auditory processing disorder limited to 8 visits per month Tympanometry, limited to 4 units per calendar year

Procedure Codes: 92506
92507
92567

Modifiers HA

Service Limits:
2 units per year; 1 unit per visit; 1 unit per 180 days

BCW Rate $60.00*

GN HA

8 visits per calendar $70.00* month; 1 unit per $46.90** visit

GN HA

4 units per calendar $20.46*

year

$15.35**

Developmental testing, limited to 2 96110

HA

2 units per calendar $13.77*

units per calendar year

year;

$10.33**

14

Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

Developmental testing extended, limited to 2 units per calendar year. 1 unit = 1 visit; therefore, may only bill 1 unit per visit
Assessment of Aphasia, limited to 2 units per calendar year. 1 unit = 1 visit; therefore, may only bill 1 unit per visit
Evaluation of oral and pharyngeal swallowing function, limited to 2 per calendar year. 1 unit = 1 visit; therefore, may only bill 1 unit per visit.
Treatment of swallowing dysfunction and/or oral function for feeding, limited to 8 visits per month; 1 unit = 1 visit
Evaluation of voice prosthesis or augmentative communication, limited to 1 unit per calendar year
Therapeutic services for the use of speech-generating device, including programming and modification; 1 unit = 1visit
Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training), direct (one-on-one) member contact by the provider; 1 unit = 15 minutes
Diagnostic analysis of cochlear implant, patient under 7 yrs. Of age with programming

96111 96105 92610 92526 92597 92609 97532
92601

Diagnostic analysis of cochlear implant, patient under 7 yrs. subsequent reprogramming.

92602

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one- on-one) member contact by the provider, 1 unit = 15 minutes
Coaching Visit

97533

IFSP Development/ Meeting (for multi-disciplinary team)

HA HA HA HA HA HA HA
GN HA GN HA GN HA

1 unit per visit
2 units per calendar year; 1 unit per visit

$64.10* $48.08**

2 units per calendar year; 1 unit per visit; 1 unit/180 days
Limited to 2 per year 1 unit per visit; 1 unit/180 days

$64.10 * $48.08**
$119.54*

8 visits per calendar $46.66* month; 1 unit per $35.00** visit

1 per calendar year; $87.57* 1 unit per visit

Limited to 8 visits per month; 1 unit per visit

$54.75* $41.06**

Limited to 8 units per calendar month or combination of 8 units per calendar month

$24.43* $18.32**

Limited to 1 unit per calendar year.

$118.23* $88.50**

Limited to 1 unit per calendar year.

$83.09* $62.32**

Limited to 8 units per calendar month or combination of 8 units per calendar month

$26.46* $19.85**

1unit = 1 visit

$60.00* $45.00**

1 unit = 1 visit 1 visit is greater than or equal to 30 minutes.

$40.00

15

Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

Excessive Travel 45-65 Miles

T2003

1unit = 1 visit

$30.00

Excessive Travel 66-85 Miles

T2003

1unit = 1 visit

$35.00

Excessive Travel 86-100 Miles

T2003

1unit = 1 visit

$40.00

*Rate for a Speech-Language Pathologist **Rate for a CFY-Speech-Language Pathologist

VISION SERVICES
Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays and abilities; Referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; and communication skills training, orientation, and mobility training for all environments, visual training, independent living skills training, and additional training necessary to activate visual motor abilities. (Title 34 CFR 303.12(d)(16))

AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Ophthalmologist, Optometrist AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING VISION SERVICES:

VISION SERVICES
Evaluation new patient intermediate Evaluation new patient comprehensive Evaluation established patient intermediate Evaluation established patient comprehensive New Patient Office Visit (problem focused) Office or other outpatient visit (expanded problem focused) Office or other outpatient visit (detailed) Office or other outpatient visit (comprehensive, moderate) Office or other outpatient visit (comprehensive, high) Office or other outpatient visit (minimal) Office or other outpatient visit

PROCEDURE CODE 92002 92004 92012 92014 99201 99202 99203 99204 99205 99211 99212

MODIFIER

SERVICE LIMIT 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit

BCW RATE $38.25 $69.86 $30.45 $48.29 $20.39 $37.91 $56.34 $83.59 $108.92 $8.48 $19.75

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates

(problem focused) Office or other outpatient visit (expanded) Office or other outpatient visit (detailed) Office or other outpatient visit (comprehensive, high) Coaching Visit

99213 99214 99215 T2022

IFSP Development/ Meeting (for multi-disciplinary team)

Excessive Travel 45-65 Miles Excessive Travel 66-85 Miles Excessive Travel 86-100 Miles

T2003 T2003 T2003

1unit = 1 visit $28.53

1unit = 1 visit $46.05

1unit = 1 visit $73.91

1 unit = 1 visit $60.00

1 unit = 1 visit 1 visit is greater than or equal to 30 minutes. 1unit = 1 visit 1unit = 1 visit 1unit = 1 visit

$40.00
$30.00 $35.00 $40.00

OTHER RELATED SERVICES
AUTHORIZED SETTING: Child Care Center, Clinic, Community Setting, Home, Hospital, Residential Facility, Special Purpose Facility
AUTHORIZED PROVIDER: Providers must maintain a contract with BCW to provide translation and interpretation services.
AUTHORIZED PROCEDURE CODES TO BE BILLED WHEN PROVIDING TRANSLATION AND INTERPRETATION SERVICES:

RELATED SERVICES
Spanish Language Translator
Non Spanish Foreign Language Translator Interpreters for the Deaf

PROCEDURE CODE
T2003

MODIFIER

T2003

T2003

SERVICE LIMIT

BCW RATE

1unit = 1 hour $50.00

1unit = 1 hour $95.00

1unit = 1 hour $75.00

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Babies Can't Wait Early Intervention Services Procedure Codes, Service Limits and Rates
APPENDIX A: MODIFIER CODES (For use with CPT Codes)

MODIFIER GN
GO
GP HA TD TS UC

DETAIL/COMMENT
Service delivered under an outpatient speech-language pathology plan of care Service delivered under an outpatient occupational therapy plan of care Service delivered under an outpatient physical therapy plan of care Child/adolescent program RN Follow-up service Medicaid level of care 12, as defined by each state

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