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. 1 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. 2 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 3 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)) 4 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 5 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)) 6 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 7 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 8 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 9 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 10 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: 11 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 12 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** 13 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 16 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 17 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 18