Chapter 538 School- Based Health Services Psychological Services August 2019

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.

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.

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.

Billing Form Medicaid Number Last Name First Name WVEIS Number   WVEIS Number Date of Birth Provider Name County School Month/Year

Billing Form Suzanne Smith Medicaid Number Last Name First Name 03900000003  Doe Aubrey WVEIS Number Date of Birth Provider Name 999999999 3-8-2008 Suzanne Smith County School Month/Year 59  501 Sept/2019

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.

LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES ICD 10 Diagnosis Codes LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES 1. 2. 3. 4. 5. 6.

LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES ICD 10 Diagnosis Codes LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES 1. F90.0 2. F91.1 3. 4. 5. 6.

Procedure codes School Based Psychological Services Procedure Service Unit   Psychiatric Diagnostic Evaluation (No Medical Services) 90791 An integrated bio-psychosocial assessment, including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies. 2 events per calendar year Event= Completed evaluation Psychological Testing, Administration and Scoring 96130 Psychological Testing Includes Integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment of planning and report and interactive feedback to the patient, family member (s) or caregiver(s); First Hour 2 units per calendar year 60-minute unit 96131 Psychological Testing: Testing and evaluation by professional; Additional Hour 4 units per calendar year * MUST USE 96130 to be able to bill for 96131 96136 Test Administration and Scoring: First 30 minutes 1 unit per calendar year 30- minute unit 96137 Additional 30 minutes 30-minute unit 96110 Developmental Testing: Limited to developmental testing with interpretation and report 2 events per calendar year. Psychotherapy Services 90832 Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 1 unit per 16-37 minutes 20 units per calendar year 90834 1 unit per 38-52 minutes 90837 1 unit per 53 or more minutes Family Psychotherapy 90846 Family Psychotherapy (without the patent present) Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development 1 unit per 45-50 minutes 90847 Family Psychotherapy (with the patient present) Group Psychotherapy 90853 Group psychotherapy is treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patters of behavior, and encourage personality growth and development. 1 unit per 60 minutes Maximum limit of 12 individuals in a group setting Psychotherapy for Crisis 90839 4 per calendar year 90840 Additional 30 Minutes of psychotherapy for crisis, used in conjunction with 90839 1 unit per 30 minutes after the initial 60 minutes from 90839

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).

List Diagnosis Code Number(s) Claim Documentation Service Date List Diagnosis Code Number(s) Procedure code   Start Time End Time Units/Event

List Diagnosis Code Number(s) Claim Documentation Service Date List Diagnosis Code Number(s) Procedure code   Start Time End Time Units/Event 9-4-2019 1 96130 9:00 10:00 9-4-2019  96131 12:00 2 9-5-2019 96136 1:30 2:00 9-5-2019  96137 3:00 9-12-2019   2 90583 1:00

Signature and Credentials _____________________ ______________ Signature/Credentials Date

Kelley Johnson – Coordinator Office of Special Education kelley Kelley Johnson – Coordinator Office of Special Education kelley.johnson@k12.wv.us 304-558-2696 ext 53539 WVDE Medicaid Website: https://wvde.us/special-education/Medicaid/