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July 6, 2006
 
 
 
MEDICAID INFORMATION RELEASE MA06-22
 
 
TO:              Personal Care Services Agencies, Aged and Disabled Waiver Agencies, Traumatic Brain Injury Waiver Agencies, Developmentally Disabled Waiver Agencies, Assisted Living Facilities, Certified Family Homes
 
FROM:        Leslie M. Clement, Administrator
 
SUBJECT:  CHANGES TO BILLING FOR INDIVIDUALS WITH A CLIENT CONTRIBUTION
 
There has been confusion in the past in billing for individuals with a client contribution.  This occurs most often when the billing week spans a month; that is, when the week starts in one month but changes to a new month somewhere within that week.  When this occurred, all services rendered for the complete week were applied against the contribution amount for the new month making it difficult to clearly see what portion was allocated to prior month.
 
Effective August 1, 2006 changes have been made to the billing system to eliminate this confusion.
 
In order to facilitate this change, when billing the codes listed below, it will be necessary to bill the code only within the month the service was delivered.  If the service spans two months, it will be necessary to bill on two lines, one for each month. The client contribution will be deducted for the month in which the service occurred.
 
This change should make it easier for individuals to understand how their client contribution is being applied and to aid providers in explaining the client contribution.
 
 
Aged and Disabled Waiver
 
Procedure Code
Service Name
Procedure Code
Service Name
S5100   U2
Adult Day Care 
T1005   U2
Respite
S5125   U2
Attendant Care 
S5120   U2       
Chore Services
S5135   U2       
Companion Services
S5115   U2       
Consultation
 
 
 
 
Procedure Code
Service Name
Procedure Code
Service Name
S5130   U2
Homemaker
T1002   U2
Nursing RN
S5140   U2
Adult Residential Care
T1003   U2
Nursing LPN
T1001   U2
Nursing RN Oversight
G9001   U2
Case Management
G9002   U2
Case Management
 
 
 
 
 
 
 
Developmental Disabilities Waiver
 
Procedure Code
Service Name
Procedure Code
Service Name
H2015   U8
Residential
0919B   U8
Residential Habilitation
H2015 HQ U8
H2022   U8
H2016   U8
Habilitation
S5140   U8
Agency Affiliation for Certified Family Home
S5121   U8
Chore Services
T1005   U8
Respite
H2023   U8
Supported Employment
T1001   U8
RN Independent
T1000   U8
Skilled Nursing RN
T1000 TE U8
LPN
T1000 TD U8    
RN
S5100   U8
Adult Day Care
H2019   U8
Case Management
 
 
 
 
 
 
 
Traumatic Brain Injury
 
Procedure Code
Service Name
Procedure Code
Service Name
H2016   U3       
TBI Daily Rate  
T1019   U3
Personal Care
97110   U3       
Physical Therapy
92507   U3
Speech Therapy
92508   U3
97535   U3
Occupational Therapy
H2015   U3
Supported Living
H2023   U3
T1005   U3
Respite
0930T   U3
Coordinator
S5140   U3       
Certified Family Home
90899   U3
Consultation
S5120   U3
S5121   U3
 
Chores
T2021   U3
Day Rehabilitation
S5125   U3
Attendant Care 
T1001   U3
RN Supervisor
T1000 TE U3    
LPN
T1000 TD U3
RN
G9002   U3
Evaluation
 
 
                       
 
If you have questions regarding this information, please contact Christine Baylis at 208-364-1891.  We appreciate your continued participation in the Idaho Medicaid Program.
 
LMC/cb/sw