Members have full access to the material and can also email us regarding any billing or compliance issue, please considerjoining todayif you need assistance. As Georgia's Behavioral Health Authority, DBHDD provides services through a network of community providers. The Department of Community Health (DCH) administers Medicaid reimbursement and associated policy for mental health treatment and services through partnership with The Department of Behavioral Health and Developmental Disabilities (DBHDD). States have great flexibility in how Medicaid payments are made to . If you do not have Adobe Acrobat Reader, you may download ithere. Physical, Occupational, and Speech Therapy Services (PDF) CP.MP.49: June 30, 2021: . Press Tab or Shift+Tab to navigate through menu. https://dbhdd.georgia.gov/community-provider-manuals, https://www.myamerigroup.com/ga/georgia-home.html, https://dbhdd.georgia.gov/access-services, Mental Health and Substance Use Disorder Parity. 455 0 obj <> endobj Please locate the pdf file where the Provider's Name would fall. As Georgias Behavioral Health Authority, DBHDD provides services through a network of community providers. Non-Member: 800-638-8255, Site Help | AZ Topic Index | Privacy Statement | Terms of Use 2021 Medicaid Enhancements to Reimbursement Policies. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. https://suicidepreventionlifeline.org/, Local and regional calls are routed from the National Suicide Prevention Lifeline to DBHDDs Georgia Crisis and Access Line (GCAL) 1-800-715-4225 https://dbhdd.georgia.gov/access-services, Voices for Georgias Children has given permission and provided the following video on Suicide Prevention: https://vimeo.com/270156589, http://georgiavoices.org/videos/suicide-prevention-psas-2/. Reimbursement rates have been recalculated effective July 1, 2020 through June 30, 2021. 2 0 obj Georgia Georgia Medicaid Coverage of Therapy Services Georgia Medicaid Coverage of Therapy Services Guidance on therapy services covered through Georgia Medicaid and other important compliance issues such as enrollment, billing, audits, and managed care. Provider Fee Payment. "@$E"Y[d$dvox`sX#@Q 1$Nw A These proprietary policies are not a guarantee of payment. Health care claims payment policies are guidelines used to assist in administering payment rules based on generally accepted principles of correct coding. These reimbursement policies apply to our Georgia Medicaid plans. Speech Therapy and Language Disorder Rehabilitation GEORGIA MEDICAID MM-0714 Effective Date: 10/01/2020 Outpatient Speech Therapy and Language Disorder Rehabilitation B. Division of Health Benefits. PDF. Resources for Audiologists Medicaid Toolkit: What Audiologists Need to Know According to Georgia Medicaid guidelines, early and periodic screening, diagnostic and treatment (EPSDT) services should follow the recommended age requirement indicated in the American Academy of Pediatrics (AAP) and Bright Futures 'Recommendations for Pediatric Health Care' periodicity schedule. /Metadata 27 0 R/Pages 453 0 R/StructTreeRoot 49 0 R/Type/Catalog/ViewerPreferences 472 0 R>> endobj 457 0 obj <>/MediaBox[0 0 612 792]/Parent 453 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 458 0 obj <>stream State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Press Space or Escape to collapse the expanded menu item. The Reimbursement Rates Sheets for FYE June 30, 2021, are located below. An official website of the State of Georgia. CPT is a registered trademark of the American Medical Association. Clinical policies help identify whether services are medically necessary based on information found in generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by the policy; and other available clinical information. Community providers of behavioral health services can be accessed by contacting The Georgia Crisis and Access Line (GCAL) at 800-715-4225 or via the web by visiting www.mygcal.com . Twitter page for Georgia Medicaid; Linkedin page for Georgia Medicaid; YouTube page for Georgia Medicaid; How can we help? An official website of the State of Georgia. In addition, Peach State Health Planmay from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendors guidelines may also be used to determine whether a service has been correctly coded. You will need Adobe Reader to open PDFs on this site. PDF. Principal Appropriate Utilization Group, LLC 881 Piedmont Avenue Atlanta, GA 30309 (404) 728-1974; FAX (404) 728-1975 [email protected] Speech_Audio_COVID_Rate_Ext FS to 1-31-22.pdf. Reimbursement policies are designed to assist you when submitting claims to CareSource. The goals of this endeavor will be implemented. It is our intent to make claim payment policies that are simple to understand and in alignment with State Medicaid Manuals. An official website of the State of Georgia. Send a Message. We believe that this will enable you and your billing staff to better understand our claims payment process given the widespread use of these policies. They are routinely updated to promote accurate coding and policy clarification. nursing services, nutrition services, occupational therapy, orthotic and prosthetic training, physical therapy and speech-language pathology. If the screening is missed, it may be performed during a catch-up visit using modifier EP and HA or UA. All rights reserved. They include, but are not limited to claims processing guidelines referenced by the Centers for Medicare and Medicaid Services (CMS), Publication 100-04, Claims Processing Manual for physicians/non-physician practitioners, the CMS National Correct Coding Initiative policy manual (procedure-to-procedure coding combination edits and medically unlikely edits), Current Procedural Technology guidance published by the American Medical Association (AMA) for reporting medical procedures and services, health plan clinical policies based on the appropriateness of health care and medical necessity, and at times state-specific claims reimbursement guidance. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. CPT copyright American Medical Association. Georgia Medicaid offers benefits on a Fee-for-Service (FFS) basis or through managed care plans. Primary: (404) 657-5468. 2200 Research Blvd., Rockville, MD 20850 Get Contracted by following the link below. Payment will be determined based upon a review of the actual services provided to a member and will be determined when the claim is received for processing. Authorization for Cancer Treatment/New Century Health, 25-Hydroxyvitamin D Testing in Children and Adolescents (PDF), Allogeneic Hematopoietic Cell Transplants for Sickle Cell(PDF), Ambulatory Surgery Center Optimization (PDF), Cosmetic and Reconstructive Surgery (PDF), Diaphragmatic/Phrenic Nerve Stimulation (PDF), Drugs of Abuse: Definitive Testing (PDF), Facility-based Sleep Studies for Obstructive Sleep Apnea (PDF), Genetic Testing Aortopathies and Connective Tissue Disorder (PDF), Genetic Testing Dermatologic Conditions (PDF), Genetic Testing Epilepsy Neurodegenerative Neuromuscular Disorder (PDF), Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF), Genetic Testing Gastroenterologic Disorders (non-cancerous) (PDF), Genetic Testing General Approach to Genetic Testing (PDF), Genetic Testing Hematologic Conditions (non-cancerous) (PDF), Genetic Testing Hereditary Cancer Susceptibility (PDF), Genetic Testing Immune Autoimmune and Rheumatoid Disorders (PDF), Genetic Testing Metabolic Endocrine and Mitochondrial Disorders(PDF), Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay(PDF), Genetic Testing Non-Invasive Prenatal Screening (NIPS)(PDF), Genetic Testing Preimplantation Genetic Testing(PDF), Genetic Testing Prenatal and Precon Carrier Screening(PDF), Genetic Testing Prenatal Diagnosis (via Amnio CVS or PUBS) and Pregnancy Loss(PDF), Genetic Testing Skeletal Dysplasia and Rare Bone Disorders(PDF), Helicobacter Pylori Serology Testing (PDF), Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (PDF), Implantable Wireless Pulmonary Artery Pressure Monitoring (PDF), Infant Apnea Monitors Clinical Policy (PDF), Intestinal and Multivisceral Transplant (PDF), Intradiscal Steroid Injections for Pain Management(PDF), IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures(PDF), Low-Frequency Ultrasound Therapy for Wound Management (PDF), Measurement of Serum 1,25-dihydroxyvitamin D (PDF), Neonatal Abstinence Syndrome Guidelines (PDF), Nerve Blocksand Neurolysis for Pain Management (PDF), Neuromuscular Electrical Stimulation (PDF), Nonmyeloablative Allogeneic Stem Cell Transplants (PDF), Oncology Circulating Tumor DNA and Circulating Tumor Cells (PDF), Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF), Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (PDF), Phototherapy for Neonatal Hyperbilirubinemia(PDF), Physical, Occupational, and Speech Therapy Services (PDF), Physical, Occupational, Speech, and Feeding Therapy (PDF), Posterior Tibial Nerve Stimulation for Voiding Dysfunction (PDF), Reduction Mammoplasty and Gynecomastia Surgery (PDF), Sacroiliac Joint Interventions for Pain Management (PDF), Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins(PDF), Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy (PDF), Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management (PDF), Skin Substitutes for Chronic Wounds (PDF), Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (PDF), Stereotactic Body Radiation Therapy (PDF), Testing for Select Genitourinary Conditions (PDF), Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (PDF), Transcather Closer of Patent Foramen Ovale (PDF), Transplant Service Documentation Requirements, Trigger Point Injections for Pain Management (PDF), Urinary Incontinence Devices and Treatments (PDF), IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (PDF), Non-myeloablative Allogeneic Stem Cell Transplants (PDF), Physical, Occupation, and Speech Therapy Services, Sclerotherapy and chemical endovenous ablation for Varicose Veins(PDF), Transcatheter Closure of Patent Foramen Ovale (PDF), Behavioral Health Treatment Document Requirement(PDF), Deep Transcranial Magnetic Stimulation for Obsessive Compulsive Disorder (PDF), Substance Use Disorder Treatment and Services (PDF), Biofeedback for Behavioral Health Disorders (PDF), Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (PDF), Adjacent Tissue Transfer Grafts involving Eyelid (PDF), Anterior Segment Photography with FA (PDF), Blepharoplasty, Ptosis and Canthoplasty (PDF), Dark Adaptation and Color Vision Examinations (92283/92284) (PDF), Destruction of a Localized Lesion of the Retina (PDF), Destruction of Localized Lesion of Choroid (PDF), Examination Guidelines for Diabetic Patients (PDF), Indocyanine Green (ICG) Angiography (PDF), Infracture of the Inferior Turbinate (PDF), Laser Iridotomy and Iridectomy for Glaucoma (PDF), Photodynamic and Intravitreal Therapies and Pharmaceuticals (PDF), Probing and Closure of the Lacrimal Duct System (PDF), Surgical Excision of Eyelid Lesions (PDF), Teleretinal Screening for Diabetic Retinopathy (PDF), Ado-Trastuzumab Emtansine (Kadcyla) (PDF), Age Limit Override (Codeine, Tramadol, Hydrocodone) (PDF), Alendronate (Binosto, Fosamax plus D) (PDF), Alpha-1 Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) (PDF), Antithymocyte Globulin (Thymoglobulin, Atgam) (PDF), Anti-Inhibitor Coagulant Complex, Human (Feiba) (PDF), Aprepitant (Emend, Cinvanti), Fosaprepitant (Emend for injection) (PDF), Aripiprazole Long-Acting Injections (Abilify Maintena, Aristada) (PDF), Baclofen (Gablofen, Lioresal, Ozobax) (PDF), Bevacizumab (Avastin, Mvasi, Zirabev) (PDF), Blocking Adjudication of Controlled Substance Prescriptions for Selected Prescribers(PDF), Brand Name Override and Non-Formulary Medications (PDF), Brexucabtagene Autoleucel (Tecartus)(PDF), Brinzolamide/Brimonidine (Simbrinza) (PDF), Budesonide Suspension (Pulmicort Respules) (PDF), Buprenorphine Implant/Injection (Probuphine, Sublocade) (PDF), Buprenorphine-Naloxone (Bunavail, Cassipa, Suboxone) (PDF), C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda) (PDF), C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda, Ruconest) (PDF), Cabozantinib (Cometriq, Cabometyx) (PDF), Ciprofloxacin-Dexamethasone (Ciprodex) (PDF), Ciprofloxacin/Fluocinolone (Otovel) (PDF), Clindamycin Phosphate/Benzoyl Peroxide (BenzaClin) (PDF), Clinical Pharmacy Services Inter-rater Reliability (PDF), Conjugated Estrogens/Bazedoxifene (Duavee) (PDF), Corticosteroid Intravitreal Implants (Iluvien, Ozurdex, Retisert, Yutiq) (PDF), Cysteamine oral (Cystagon, Procysbi) (PDF), Cytomegalovirus Immune Globulin (Cytogam)(PDF), Desmopressin Acetate (DDAVP, Stimate, Noctiva) (PDF), Dextromethorphan-Quinidine (Nuedexta) (PDF), Dimethyl Fumarate (Tecfidera), Diroximel Fumarate (Vumerity) (PDF), Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (PDF), Doxepin (Silenor, Prudoxin, Zonalon) (PDF), Doxycycline Hyclate (Acticlate, Doryx), Doxycycline (Oracea) (PDF), Early and Periodic Screening, Diagnostic, and Treatment Benefit for Pediatric Members (PDF), Elexacaftor/Ivacaftor/Tezacaftor; Ivacaftor (Trikafta) (PDF), Emtricitabine/Tenofovir Alafenamide (Descovy)(PDF), Everolimus (Afinitor, Afinitor Disperz, Zortress) (PDF), Factor IX Complex, Human (Profilnine) (PDF), Factor VIIa, Recombinant (NovoSeven RT) (PDF), Factor VIIa, Recombinant (NovoSeven RT, SevenFact) (PDF), Factor XIII A-Subunit, Recombinant (Tretten) (PDF), Fam-trastuzumab Deruxtecan-nxki (Enhertu) (PDF), Fentanyl IR (Abstral, Actiq, Fentora, Lazanda, Subsys) (PDF), Filagrastim (Neupogen), Filagrastim-sndz (Zarxio), Tbo-filagrastim (Granix) (PDF), Formulary Medications without Specific Guidelines (PDF), Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (PDF), Granisetron (Kytril, Sancuso, Sustol) (PDF), histrelin acetate (Vantas, Supprelin LA) (PDF), Hydroxyprogesterone Caproate (Makena/compound), Indacaterol/Glycopyrrolate (Utibron Neohaler) (PDF), Infertility and Fertility Preservation (PDF), Infliximab (Remicade, Inflectra, Renflexis) (PDF), Insulin Delivery Systems (V-Go, OmniPod, InPen) (PDF), Interferon beta-1b (Betaseron, Extavia) (PDF), Intrathecal Baclofen (Gablofen, Lioresal) (PDF), Isotretinoin (Absorica, Absorica LD, Amnesteem, Claravis, Myorisan, Zenatane) (PDF), Itraconazole (Sporanox, Onmel, Tolsura) (PDF), Lesinurad (Zurampic), Lesinurad/Allopurinol (Duzallo) (PDF), leuprolide acetate (Eligard, Lupaneta Pack, Lupron Depot, Lupron Depot-Ped) (PDF), Levalbuterol (Xopenex HFA/Inhalation Solution) (PDF), Lidocaine Transdermal (Lidoderm, ZTlido) (PDF), Lutetium Lu 177 Dotatate (Lutathera)(PDF), Montelukast oral granules (Singulair) (PDF), Methotrexate (Otrexup, Rasuvo, Xatmep, Reditrex) (PDF), Methoxy polyethylene glycol-epoetin beta (Mircera) (PDF, Methylnaltrexone Bromide (Relistor) (PDF), Minocycline ER (Solodyn, Ximino, Minolira) and Microspheres (Arestin) (PDF), Moxetumomab pasudotox-tdfk (Lumoxiti) (PDF), Multiple Procedure Payment Reduction (MPPR) for Therapeutic Services (PDF), Nadofaragene Firadenovec (Instiladrin) (PDF), Naproxen oral suspension (Naprosyn) (PDF), Neomycin/Fluocinolone Cream (Neo-Synalar)_(PDF), Netarsudil (Rhopressa), Netarsudil/Latanoprost (Rocklatan) (PDF), Netupitant and Palonosetron (Akynzeo), Fosnetupitant and Palonosetron (Akynzeo IV) (PDF), No Coverage Criteria/Off-Label Use Policy (PDF), Non-Formulary and Formulary Contraceptives (PDF), Octreotide (Sandostatin, Sandostatin LAR) (PDF), Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia) (PDF), Olanzapine Long-Acting Injection (Zyprexa Relprevv)(PDF), Onasemnogene Abeparvovec (Zolgensma) (PDF), Paclitaxel, Protein-Bound (Abraxane) (PDF), Peanut Allergen Powder-dnfp (Palforzia) (PDF), Pegaspargase (Oncaspar), Calaspargase pegol-mknl (Asparlas) (PDF), peginterferon alfa-2b (PegIntron, Sylatron) (PDF), Pharmacy and Therapeutics Committee(PDF), Pharmacy Prior Authorization and Medical Necessity Criteria(PDF), Potassium Chloride for Oral Solution (Klor-Con Powder) (PDF), Propranolol HCl Oral Solution (Hemangeol) (PDF), Protein C Concentrate, Human (Ceprotin) (PDF), Repository Corticotropin Injection (H.P.
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