An official website of the State of Georgia. 3a, Col 003, line 019: 36) Capital Related - Buildings & Fixtures (All Agencies Statewide) Sch. The Initial Reimbursement Rate Sheets for FYE June 30, 2022, are located below. Non-Member: 800-638-8255, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Additionally, monaural hearing aids, when billed, must be reported with modifier RT or LT and are limited to one unit per side in a three-year period. Additionally, laws and regulations and insurance and payer policies are subject to change. According to Georgia Medicaid guidelines, the telehealth originating site facility fee must be reported with modifier EP (EPSDT program) and modifier GT (Via interactive audio or video telecommunication systems) when billed in a school setting. All policies found in the Peach State Health PlanPayment Policy Manual apply with respect to Peach State Health Planmembers. Provider Fee Payment | Georgia Department of Community Health Reimbursement rates have been recalculated effective July 1, 2020 through June 30, 2021. stream Members also have access to compliance and billing support. PDF. 455 0 obj <> endobj If you do not have Adobe Acrobat Reader, you may download ithere. According to Georgia Medicaid guidelines, the insertion of an implantable contraceptive device and the implantable contraceptive reported as part of a Medicaid family planning program is limited to once in a three-year period. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Local, state, and federal government websites often end in .gov. nursing services, nutrition services, occupational therapy, orthotic and prosthetic training, physical therapy and speech-language pathology. @,[whrDK 8v`{w)[A!#M~F1" &(BP Speech_Audio_COVID_Rate_Ext FS to 1-31-22.pdf. Get Contracted by following the link below. The NDC serves as a universal product identifier for drugs. The Initial Reimbursement rates for FYE June 30, 2021, are located below. Payments for claims may be subject to limitations and/or qualifications. PDF Georgia State Board of Speech-Language Pathology/Audiology reimbursement rate is 85.6% of costs. aJY $,0V #hE2!FF!&`B+4fC&%@ c cTh Other policies (e.g., clinical policies) or contract terms may further determine whether a technology, procedure or treatment that is not addressed in the Payment Policy Manual is payable by Peach State Health Plan. This area of the Billing and Reimbursement site provides information on the major aspects of Medicaid related to audiology and speech-language pathology services, including audiology and speech-language pathology requirements and information for school based professionals. In turn, the plan pays providers for all of the Medicaid services a beneficiary may require that are included in the plans contract with the state. Reimbursement policies are designed to assist you when submitting claims to CareSource. Fee Schedules - Georgia NHP Rate Sheet Archive | Georgia Department of Community Health 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. Answers to frequently asked questions about Medicaid and audiology and speech-language pathology services. Please note that the reimbursement rate sheets (R-32) are in alphabetical order. CPT is a registered trademark of the American Medical Association. According to Georgia Medicaid guidelines, certain provider administered drugs must be reported with the National Drug Code (NDC) that corresponds directly to the drug related procedure code. The Lifeline supports people who call for themselves or someone they care about. Each state determines reimbursement rates and coverage of services. Peach State Health Plan utilizes InterQualcriteria for those medical technologies, procedures or pharmaceutical treatments for which a Peach State Health Planclinical policy does not exist. 04/01/2023. All rights reserved. It is our intent to make claim payment policies that are simple to understand and in alignment with State Medicaid Manuals. Please enable Cookies and reload the page. %%EOF Clinical policies are one set of guidelines used to assist in administering health plan benefits, either by prior authorization or payment rules. Under the FFS model, Georgia pays providers directly for each covered service received by a Medicaid beneficiary. An official website of the State of Georgia. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. Age Requirements. 1997- American Speech-Language-Hearing Association. They are used to help identify whether health care services are correctly coded for reimbursement. Appropriate Use and Safety Edits: Attachment A(PDF), Pharmacy Prior Authorization and Medical Necessity Criteria (PDF). "@$E"Y[d$dvox`sX#@Q 1$Nw A . WellCare Health Plans is committed to continuously improving its claims review and payment processes. Completing the CAPTCHA proves you are a human and gives you temporary access to the web property.

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