LOUISIANA MEDICAID PROGRAM ISSUED: 01/20/17 REPLACED: 06/29/16 CHAPTER 38: RESIDENTIAL OPTIONS WAIVER APPENDIX E: BILLING CODES PAGE(S) 15
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1 APPENDIX E: BILLING S PAGE(S) 15 BILLING S The following chart describes the codes and rates (effective September 1, 2015) that are to be used with the Options. Providers must bill the appropriate procedure code for the service performed. TYPE SPEC OF Case Management Case Management Support Coordination Support Coordination T1016 $ min Support Coordination- High need Transition Funding T1016 TG $ min 12 per month 144 annually 24 per month 288 annually Community Transition 2 4A One time transition service T2038 $3000 Life time maximum limit Community Living Supports () Attendant Care Community Living Supports 1 Person S5125 $ min Attendant Care Community Living Supports 2 Persons S5125 UN $ min Attendant Care Community Living Supports 3 persons S5125 UP $ min -Children under 18 () Foster Care Foster Care Foster Care Foster Care Level 1 Level 2 Level 3 Level 4 S5140 HA $51.11 Per diem S5140 TF HA $55.07 Per diem S5140 TG HA $62.21 Per diem S5140 U2 HA $66.91 Per diem Page 1 of 15
2 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF -Adults 18 and over () Foster Care Adult Level 1 S5140 $51.11 Per diem Foster Care Adult Level 2 S5140 TF $55.07 Per diem Foster Care Adult Level 3 S5140 TG $62.21 Per diem Foster Care Adult Level 4 S5140 U2 $66.91 Per diem Companion Care () Companion Care, Adult Companion Care S5136 $39.58 Per diem Shared Living -New (Up to 3 people) Provider Leased or Owned Residence (), 4G Shared Living Level 1 T2016 $79.47 Per diem 4G Shared Living Level 2 T2016 TF HQ $87.66 Per diem 4G Shared Living Level 3 T2016 TG HQ $ Per diem 4G Shared Living Level 4 T2016 U2 HQ $ Per diem Shared Living-New (Up to 3 people) Participant Leased or Owned Residence (), 4L Shared Living Level 1 T2016 HQ $79.47 Per diem 4L Shared Living Level 2 T2016 TF HQ $87.66 Per diem Page 2 of 15
3 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF Shared Living-New (Up to 3 people) Participant Leased or Owned Residence () continued 4L Shared Living Level 3 T2016 TG HQ $ Per diem 4L Shared Living Level 4 T2016 U2 HQ $ Per diem Shared Living-Conversion/Provider Leased or Owned Residence () 4J Shared Living Level 1 T2033 UQ $59.66 Per diem 4J Shared Living Level 2 T2033 TF UQ $67.66 Per diem 4J Shared Living Level 3 T2033 TG UQ $81.92 Per diem 4J Shared Living Level 4 T2033 U2 UQ $ Per diem Shared Living-Conversion/Participant Leased or Owned Residence () 4H Shared Living Level 1 T2033 UQ $59.66 Per diem 4H Shared Living Level 2 T2033 TF UQ $67.66 Per diem 4H Shared Living Level 3 T2033 TG UQ $81.92 Per diem 4H Shared Living Level 4 T2033 U2 UQ $ Per diem Page 3 of 15
4 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF Shared Living-Conversion/Provider Leased or Owned Residence () 4J Shared Living Level 1 T2033 $59.66 Per diem 4J Shared Living Level 2 T2033 TF HQ $67.66 Per diem 4J Shared Living Level 3 T2033 TG HQ $81.92 Per diem 4J Shared Living Level 4 T2033 U2 HQ $ Per diem Shared Living-Conversion/Participant Leased or Owned Residence () 4H Shared Living Level 1 T2033 HQ $59.66 Per diem 4H Shared Living Level 2 T2033 TF HQ $67.66 Per diem 4H Shared Living Level 3 T2033 TG HQ $81.92 Per diem 4H Shared Living Level 4 T2033 U2 HQ $ Per diem Respite Respite Care Respite Care - Out of Home T1005 HQ $ min 720 hours Personal Emergency Response System Personal Emergency Response System Personal Emergency Response System Installation S5160 $30.00 Installation Monthly Service Fee S5161 $27.00 Monthly Page 4 of 15
5 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF Local Trip Local Trip (W/C) Assistive Technology/ Specialized Medical Equipment Specialized Medical Equipment, Not otherwise specified (NOS) 42 4X 01 4A 42 4X 01 4A ( ) Regular - (Comm Access) Wheel chair (Comm Access) Adaptation/Accessibility Assistive Technology Specialized Medical Equip. and Supplies Repairs Specialized Medical Equipment and Assistive Technology Z5177 $5.58 One-way 730 Z5186 $9.32 One-way 730 T2029 T2029 RB Per Item/ Service Per Item/ Repair Environmental Modifications Environmental Accessibility Adaptations Z0620 Per Service Supported Employment Vocational Supported Employment, Individual Job and Assistance with Micro Enterprise H2023 TT $ min (Minimum number of service hours is 1 hour) 32 units per day Supported Employment Supported Employment, Mobile Crew or Enclave H $ hours 2 units per day Non-Emergency Regular for Supported Employment T2003 SE $5.58 One way Non-Emergency Wheel chair for Supported Employment A0130 SE $9.32 One way, Prevocational Pre-Vocational T $ hours 10 units per week Non-Emergency Regular for Prevocational T2003 $5.58 One way 10 units per week Page 5 of 15
6 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF Vocational (continued) Non-Emergency Wheel chair for Prevocational A0130 $9.32 One way 10 units per week Day Day T2020 $ hours 10 units per week Non-Emergency Regular for Day T2003 U6 $5.58 One way 10 units per week Non-Emergency Wheel chair for Day A0130 U6 $9.32 One way 10 units per week Nursing In Home Nursing Care by LPN of Skilled Nurse In Home Health Setting In Home Nursing Care by LPN In Home Nursing Care by LPN RN Intermittent LPN-Intermittent (1 person) LPN-Intermittent (up to 4 persons) LPN-Extended (1 person) LPN-Extended (up to 2 persons) Nursing RN (1 person) G0154 TE $53.01 Per visit G0154 TE TT $26.51 Per visit S9124 $30.89 Per hour S9124 TT $15.44 Per Hour G0154 TD $57.19 Per visit RN Extended Nursing RN (up to 2 persons) S9123 TT $16.41 Per hour RN Extended Nursing RN (1 person) S9123 $32.82 Per hour RN Intermittent Nursing RN (up to 4 persons) G0154 TD TT $32.86 Per visit Page 6 of 15
7 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF (Registered Dietician) 41,11, 84 4R Registered Dietician (Individual) $ min 41,11, 84 4R Registered Dietician (Individual, Subsequent) $ min 41,11, 84 4R Registered Dietician (Group) $ min () Evaluation of Speech Fluency (e.g. stuttering, cluttering) $ min Evaluation of Speech sound production (e.g. articulation, phonological process, apraxia, dysarthria) 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) Behavioral and Qualitative Analysis of Voice and Resonance (Speech Language Hearing Therapy) (Laryngeal function studies) $ min $ min $ min $ min $ min Page 7 of 15
8 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF () continued (Oral function therapy) (Evaluation for nonspeech device RX ) (Non-speech device service) (Ex for speech device RX) (Evaluate swallowing function) (Therapeutic activities) (Cognitive skills development) $ min $ min $ min $ min $ min GN $ min GN $ min () A 84 (OT Evaluation low complex 30 min) (OT Evaluation mod complex 45min) (OT Evaluation high complex 60 min) (OT re-evaluation est plan of care) (Application of hot or cold packs) (Application of Traction, Mechanical) (Application of electrical stimulation/ unattended) $ min $ min $ min $ min GO $ min GO $ min GO $ min Page 8 of 15
9 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF () continued (Application of paraffin bath) (Application of whirlpool) (Application of electrical stimulation/ manual) (Application of lontophoresis) (Application of ultrasound) (OT Therapeutic Procedure) (Massage therapy) (Manual therapy) (Therapeutic activities) (Cognitive skills development) (Wheelchair management) GO $ min GO $ min GO $ min GO $ min GO $ min GO $ min GO $ min GO $ min GO $ min GO $ min GO $ min Page 9 of 15
10 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF () (PT Evaluation low complex 20 min) (PT Evaluation mod complex 30 min ) (PT Evaluation high complex 45 min ) (PT re-evaluation est plan of care) (Application of hot or cold packs) (Application of traction, mechanical) (Application of electrical stimulation/ unattended) (Application of paraffin bath) (Application of whirlpool) (Application of electrical stimulation/ manual) (Application of lontophoresis) (Application of ultrasound) (Therapeutic Procedure) (neuromuscular re-education) (Gait training) Page 10 of $ min $ min $ min $ min GP $ min GP $ min GP $ min GP $ min GP $ min GP $ min GP $ min GP $ min GP $ min $ min $ min
11 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF () continued (Massage therapy) (Manual therapy) (Therapeutic activities) (Wheelchair Management) (Social Work) (Family psychotherapy) (Group psychotherapy) (Assess Hlth/ Behave, Init) (Self-care Management Training) (Community/ Work Reintegration) (Home visit assistance w/adl s and personal care) (Home Visit, Sing/M/Fam Counseling) (Unlisted Home Visit Service or Procedure) GP $ min GP $ min GP $ min GP $ min AJ $ min AJ $ min AJ $ min AJ $ min AJ $ min AJ $ min AJ $ min AJ $ min Page 11 of 15
12 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF (Social Work) continued (HHCP-SVS of CSW) (Assertive Community treatment face to face) (Mental Health, NOS) (Crisis Intervention) (Skilled Training and Development) (Psychosocial Rehab ) (Therapeutic Behavior Service) (Community-based Wrap Around) (Psychology) (Diagnostic Interview) (Interactive Psychological Diagnostic Interview) (Individual Psychotherapy) G0155 $ min H0039 AJ $ min H0046 AJ $ min H2011 AJ $ min H2014 $ min H2017 AJ $ min H2019 AJ $ min H2021 AJ $ min $ min $ min $ min Page 12 of 15
13 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF (Psychology) continued (Individual Psychotherapy, Utilizing Equipment/ Devices) (Family psychotherapy) (Special Family Therapy) (Group Psychotherapy) (Interactive Group Psychotherapy) (Pharmacologic Management) (Psychological Testing by (Psychological Testing by Tech) (Neuropsychological testing) (Assess Hlth/Behave, Init) (Self-care Management Training) $ min $ min AH $ min AH $ min $ min $ min $ min $ min $ min AH $ min AH $ min Page 13 of 15
14 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF (Psychology) continued (Community/ Work Reintegration) (Home visit for Assistance with ADL s and Personal Care) (Home Visit, Sing/M/Fam Counseling) (Unlisted Home Visit Service or Procedure) (Assertive Community Treatment Face to Face) (Mental Health, NOS) (Crisis Intervention) (Psychosocial Rehab ) (Therapeutic Behavior Service) (Community-based Wrap Around) AH $ min AH $ min AH $ min AH $ min H0039 AH $ min H0046 AH $ min H2011 AH $ min H2017 AH $ min H2019 AH $ min H2021 AH $ min Page 14 of 15
15 APPENDIX E: BILLING S PAGE(S) 15 TYPE SPEC OF Dental Dental 27 Dental 27 Dental 27 19, 66, 67, 68 19, 66, 67, 68 19, 66, 67, 68 Dental (Periodic Oral Examination, Patient of Record) Dental (Comprehensive Oral Examination, New Patient) Dental (Radiographs, Complete Series including Bitewings) D0120 $30.95 D0150 $53.47 D0210 $67.72 Per procedure Per procedure Per procedure Dental 27 19, 66, 67, 68 Dental (Prohylaxis-Adult) D1110 $52.77 Per procedure Permanent Supportive Housing Permanent Supportive Housing Permanent Supportive Housing Supports AW Housing Stabilization Z0648 AW Housing Stabilization Transition Z0649 $15.11/ 15 Min. $60.44/ hr. $15.11/1 5 Min. $ units annually 93 units annually Page 15 of 15
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