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July 7, 2006
 
 
 
MEDICAID INFORMATION RELEASE MA06-25
 
TO:                 Developmental Disability Centers (DD), Mental Health Clinic (MHC) and
                        Mental Health Rehabilitation (MHR) Providers
 
FROM:           Leslie M. Clement, Administrator
 
SUBJECT:     CHANGES TO MEDICAID REIMBURSEMENT RATES
 
Effective July 1, 2006, the following table reflects increases to reimbursement rates for the following services:
Provider
HCPCS Code
Modifier
Description
New Rate
DD
97003
 
OCCUPATIONAL THERAPY EVALUATION -1 UNIT= 15 MIN
$14.00
DD
97535
HQ
OCCUPATIONAL THERAPY/GROUP -1 UNIT= 15 MIN
$3.59
DD
97535
 
OCCUPATIONAL THERAPY-INDIVIDUAL -1 UNIT= 15MIN.
$14.00
DD
97001
 
PHYSICAL THERAPY EVALUATION -1 UNIT= 15 MIN
$14.00
DD
97150
 
PHYSICAL THERAPY GROUP -1 UNIT= 15 MIN
$3.59
DD
97110
 
PHYSICAL THERAPY INDIVIDUAL -1 UNIT=15 MIN
$14.00
DD
90801
 
PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAM, 1 UNIT = 15 MIN
$16.46
DD
90847
U4
PSYCHOTHERAPY FAMILY FOR NF RECIPIENT; 1 UNIT=15 MIN
$12.84
DD
90847
 
PSYCHOTHERAPY FAMILY MEDICAL  1 UNIT = 15 MIN
$12.84
DD
90853
 
PSYCHOTHERAPY GROUP MEDICAL  1 UNIT = 15 MIN
$3.89
DD
H0004
 
PSYCHOTHERAPY INDIVIDUAL MEDICAL , 1 UNIT = 15 MIN
$14.35
DD
92506
 
SPEECH EVALUATION -1 UNIT= 15 MIN
$14.00
DD
92508
 
SPEECH THERAPY GROUP  -1 UNIT= 15 MIN
$4.37
DD
92507
 
SPEECH THERAPY INDIVIDUAL -1 UNIT=15 MIN
$14.00
MHC
97535
 
OCCUPATIONAL THERAPY - INDIVIDUAL - 1 UNIT= 15 MIN
$14.00
MHC
90847
U4
PSYCHOTHERAPY FAMILY FOR NF RECIPIENT;1 UNIT = 15 MIN
$12.84
MHC
90899
U4
PSYCHOTHERAPY INDIVIDUAL INTERACTIVE NF RECIPIENT
1 UNIT=15
$16.74
MHR
97003
 
OCCUPATIONAL THERAPY EVALUATION 1 UNIT = 15 MIN
$14.00
MHR
97535
 
OCCUPATIONAL THERAPY-INDIVIDUAL -1 UNIT= 15MIN.
$14.00
MHR
90847
 
PSYCHOTHERAPY FAMILY
$12.84
MHR
90847
U4
PSYCHOTHERAPY FAMILY FOR NF RECIPIENT; 1 UNIT=15 MIN
$12.84
MHR
H0004
U4
PSYCHOTHERAPY INDIVIDUAL FOR NF RECIPIENT; 1 UNIT = 15 MIN
$12.84
 
These rates are being adjusted in order to bring them into alignment with rates paid to other community-based providers.  If the market analysis results show that payment increases were not warranted, the Department may make additional changes to these reimbursement rates to reflect the results of the market analysis.
 
If you have any questions please contact Gynna Loper, Senior Financial Specialist in the Office of Medicaid Reimbursement Policy, at (208) 364-1994.
 
Thank you for your continued participation in the Idaho Medicaid program.
 
LMC/gl/sw