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Ohio Medicaid Expansion of PT/OT Telehealth

Telehealth Billing Guidelines During COVID-19 State of Emergency

Applies to dates of service on or after March 9, 2020 until end of State of Emergency

Providers may start billing FFS and to the MCPs under these guidelines once system changes are implemented on April 15, 2020, with the exception of the end stage renal disease (ESRD)-related services and some of the skilled therapies services, as noted in the detailed guidance below; the claims processing implementation date for these services will be released in a forthcoming communication. The Claims for dates of service beginning March 9, 2020 and for the duration of the state of emergency will be considered valid under these guidelines.

When billing for professional services:

    •  Most procedure codes should be reported with the “GT” modifier to identify the service delivery through telehealth. See instructions for your specific program areas for further clarification.
    • In most cases, the place of service reported on the claim must be the location of the practitioner. See instructions for your specific program areas for further clarification.
    • If applicable, any other required modifiers must be reported.

Outpatient Hospital Billing

Hospital providers are eligible to bill for telehealth services identified in the Appendix to Ohio Administrative Code (OAC) rule 5160-1-21 to the extent they appear on the EAPG covered code list, located on our website: https://www.medicaid.ohio.gov/provider/feescheduleandrates.

To bill outpatient hospital telehealth services, please append modifier “GT” to the procedure code. If telehealth services are performed as a result of the COVID-19 pandemic, please also append Modifier “CR” – Catastrophe/Disaster to the applicable procedure codes and include Condition Code “DR” – Disaster Related at the header level of the institutional claim.

Outpatient hospital telehealth services will pay according to the Enhanced Ambulatory Patient Grouping (EAPG) pricing methodology as described in OAC rule 5160-2-75.

Home Health Services, RN Assessment and RN Consultation

Home health services, the RN assessment service and the RN consultation service can be provided using telehealth when clinically appropriate. These services should be billed using the procedure codes below. The value “02” should be used to indicate telehealth as the “Place of Service” on all claims for services provided using telehealth.

    • G0156 Home Health Aide
    • G0299 Home Health Nursing – RN
    • G0300 Home Health Nursing – LPN
    • T1001 RN Assessment
    • T1001 w/U9 Modifier – RN Consultation
    •  G0151 Physical Therapy
    • G0152 Occupational Therapy
    • G0153 Speech-Language Pathology

Occupational Therapy, Physical Therapy, Speech-Language Pathology, and Audiology Services As Found in OAC 5160-8-36

92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual

92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals

92521 Evaluation of speech fluency (e.g., stuttering, cluttering)

92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);

 92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)

92524 Behavioral and qualitative analysis of voice and resonance

92526 Treatment of swallowing dysfunction and/or oral function for feeding

92556 Speech audiometry threshold; with speech recognition

92601 Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming

92602 Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming

92603 Diagnostic analysis of cochlear implant, age 7 years or older; with programming

92604 Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming

92606 Therapeutic service(s) for the use of non-speech-generating device, including programming and modification

92607 Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour 92608 Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure)

92609 Therapeutic services for the use of speech-generating device, including programming and modification

 96110 Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument

96112 Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour

96113 Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes 18

97161 Physical therapy evaluation: low complexity. Typically, 20 minutes are spent face-toface with the patient and/or family.

97162 Physical therapy evaluation: moderate complexity. Typically, 30 minutes are spent face-to-face with the patient and/or family.

97164 Re-evaluation of physical therapy established plan of care. Typically, 20 minutes are spent face-to-face with the patient and/or family.

97165 Occupational therapy evaluation, low complexity. Typically, 30 minutes are spent face-to-face with the patient and/or family.

97166 Occupational therapy evaluation, moderate complexity. Typically, 45 minutes are spent face-to-face with the patient and/or family.

97168 Re-evaluation of occupational therapy established plan of care. Typically, 30 minutes are spent face-to-face with the patient and/or family.

97129 Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes

97130 Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes (list separately in addition to code for primary procedure)

97530 Therapeutic activities

97532 Cognitive skills development

97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes

97535 Self-care/home management training (eg, activities of daily living [ADL] and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes

The following skilled therapies can be delivered via telehealth, but will not be billable with the GT Modifier until a date yet to be determined.  If delivered via telehealth, please bill the following services as if they were delivered face-to-face until additional guidance is provided by ODM.

97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

97116 Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)

97163 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care

97167 Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance

97750 Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes

97755 Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes

97760 Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes 97761 Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes

Reference

https://medicaid.ohio.gov/Portals/0/Providers/COVID19/TelehealthBillingGuidelinesDuringCOVID-19StateofEmergency04132020.pdf?ver=2020-04-13-165849-963

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