Cigna/Aetna
This discipline requires a GN modifier on all charges that are billed out.
What is speech therapy
True or False - OT and PT evaluations require prior authorization.
True - OT and PT evaluations DO require prior authorization within 24 hours of the evaluation being completed, as the TREATMENT portion of the evaluation requires the authorization. ST evaluations DO NOT require prior authorization, as there is no TREATMENT code billed during the evaluation.
This insurance requires and evaluation and treatment to be documented and billed during the initial evaluation.
Anthem BCBS and Meritian/Coventry
True or False: DMH billing requires the use of a discipline specific modifier when billing.
False
True or False - this insurance is considered a per unit insurance.
FALSE - this insurance is considered a flat rate insurance. The billed units ALWAYS reflect as 1 regardless of the time logged.
What modifier is required when billing for speech therapy services?
What is EP
This modifier distinguishes between group and individual Speech Therapy services.
59 Modifier with 92507
This insurance is considered a flat rate insurance and does NOT recognize time.
What is Meritain/Coventry
This insurance can be extended from a 30 minute treatment to a 60 minute treatment pending ONLY parent approval.
Missouri Care or Home State
This insurance only allows for 15 minutes for an OT/PT evaluation, and 45 minutes for treatment within that evaluation visit.
During a social language group session, what CPT code requires a 59 modifier?
What is 92507
This discipline(s) evaluation requires prior authorization within 24 hours of evaluation.
PT OT and ST evaluations.
This insurance allows ONLY 30 minutes to be billed for individual based treatment intervention during Chatterbox class.
Anthem BCBS
L1906
This insurance allows 60 minutes for an OT PT or SLP evaluation.
What is Cigna.
What code defines Therapeutic Activities?
97530
This discipline allows for up to 8 units for an evaluation, and requires what Modifier?
Speech Therapy Evaluation - GN and EP modifiers.
True or False - Speech Therapy services requires an EP modifier for services to billed correctly under Anthem and Meritian insurances.
False - only a GN modifier is required for both Anthem and Meritain/Coventry
This insurance frequently uses the CPT code 97535 "Functional Therapy Activity"
Theramatrix
This discipline requires a 59 modifier when using an individual/group code during social language groups or chatterbox.
What modifier is required for OT and PT services with this insurance?
No modifier is required with Missouri care for PT and OT charges.
These CPT codes are utilized to evenly distinguish between individual and group therapy intervention during Chatterbox.
92507 and 92508
This insurance requires GP GO and GN modifiers for PT OT or ST services.
Anthem BCBS and Meritain/Coventry
These 6 insurances are considered to be a flat rate insurance that DOES NOT recognize time.
UHC
UMR
UHSS
Cigna
Meritain
Coventry