ABA Fee Schedule (Effective January 1, 2021) CPT D Code escription Provider Rate Ti me Daily Max Li itations 97151 Behavior identification . 97152. Billing Code Matrix. Northwood Children's Services-West Campus. Herein, the reported commercial insurance rates repre-sent third-party payment to the service provider and do not include patient cost-share amounts. The IHS rate is mandated by the Department of Health and Human Services and is published yearly in the Federal Register. . MAGELLAN VA MEDICAID/DMAS RATES Interactive Complexity Addon Observation Care Discharge Family/Couples Psychotherapy w/ patient present, 50 min* Office Outpatient Visit, Established patient, minor* Psychotherapy w/ patient, 30 min, w/ E&M svc* Group Psychotherapy* Fourteen associated Category III codes (0359T, 0360T, 0361T, 0363T-0372T and 0374T) have been deleted. Metal Health Skill Building. Visit our Forms and publications page to download authorization forms. %%EOF Financial Management Services, FEA - Service Code 490 - The maximum rates are $45.88 per consumer per month for one Participant-Directed Service, $71.37 per consumer per month for two or three Participant-Directed . Please contact our Provider Service Line at 877-614-0484 with any questions regarding your participation and group model verses facility model. escription Provider Rate Ti me Daily Max Li itations 97155/ 97155 (GT) Adaptive behavior treatment direction Psychologist/ BCBA-D/BCBA $29.60 15 minutes . Nursing Facility Rate list; Outpatient Hospital Radiology Fee Schedules: 2021; 2020; 2019; 2018; Outpatient Hospital Surgical Procedural Fee Schedules: Effective 01/01/19 (updated 11/30/18) Outpatient Hospital Lab Fee Schedules: Effective 01/01/21 (updated 04/08/21) Outpatient Hospital Simplified Fee Schedules: Effective 7/20/2021; Effective 7 . If you need assistance, please contact the Executive Office of Health and Human Services. The rates depicted are either the actual rate calculated or the current rate less 15%, whichever is higher. iBudget Waiver Rate Changes Effective July 1, 2022. Notice: Past billing guides may have broken links. All claims must be submitted by BCBA/BCBA-D for services covered under the Autism Care Demonstration (ACD). The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Effective February 1, 2022, Applied Behavior Analysis (ABA) is a covered benefit for Medicaid enrollees in Texas who have autism spectrum disorder (ASD). 40 Hours Specialized Training Competency Assessment by master's Level Ongoing Supervision by master's Level National Optum Marylandhas provided a listing of Mental Health, Substance Use Disorder and other specific levels of care by fee schedules for Providers to use. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept". hb```,@(qiem!aL=(:h ?30n,- kq]P.S5v(f`Z10c`t3j+Q % U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. 2. 101 CMR 358.00: Rates of Payment for Applied Behavior Analysis This is an unofficial version of Commonwealth regulations and is posted here for the convenience of the public. Going . Use the ProviderOne portal to see if a client is eligible for the service and the billing guides and fee schedules to determine if a PA is required. High School Background Check . U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements. Share sensitive information only on official, secure websites. Please limit your input to 500 characters. For Apple Health clients and clients of the Developmental Disabilities Administration. This Agreement will terminate upon notice if you violate its terms. How the Defense Intrepid Network for TBI and Brain Health addresses the full continuum of care for traumatic brain injury, behavior health, and brain health. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, Community behavioral support (CBHS) services, First Steps (maternity support & infant care), Ground emergency medical transportation (GEMT), Home health care services: electronic visit verification, Substance use disorder (SUD) consent management guidance, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19), Information about novel coronavirus (COVID-19) webpage, Medical Assistance Customer Service Center (MACSC) online, October 1, 2022 to present ABCD billing guide, July 1, 2022 to September 30, 2022 ABCD billing guide, April 15, 2022 to June 30, 2022 ABCD billing guide, July 1, 2022 to present Acute physical medicine and rehabilitation billing guide, October 1, 2020 to June 30, 2022 Acute physical medicine and rehabilitation billing guide, January 1, 2020 to September 30, 2020 Acute physical medicine and rehabilitation billing guide, View all acute physical medicine and rehabilitation billing guides, July 1, 2022 to present Alien Medical Program billing guide, January 1, 2022 to June 30, 2022 Alien Medical Program billing guide, April 1, 2021 to December 31, 2021 Alien Medical Program billing guide, View all Alien Medical Program emergency assistance billing guides, January 1, 2021 to present Ambulance transportation billing guide, July 1, 2020 to December 31, 2020 Ambulance transportation billing guide, April 1, 2020 to June 30, 2020 Ambulance transportation billing guide, View all Ambulance transportation billing guides, July 1, 2022 to present Ground Emergency Medical Transportation (GEMT) billing guide, October 1, 2020 to June 30, 2022 Ground Emergency Medical Transportation (GEMT) billing guide, January 1, 2020 to September 30, 2020 Ground Emergency Medical Transportation (GEMT) billing guide, July 1, 2021 to present Ambulance transportation, February 29, 2020 to June 30, 2021 Ambulance transportation, July 1, 2019 to February 28, 2020 Ambulance transportation, December 1, 2016 to June 30, 2019 Ambulance transportation, January 1, 2006 to November 30, 2016 Ambulance transportation, July 1, 2022 to present ACS billing guide, July 1, 2021 to June 30, 2022 ASC billing guide, October 1, 2020 to June 30, 2021 ASC billing guide, October 1, 2022 to present ASC fee schedule, April 1, 2022 to September 30, 2022 ASC fee schedule, October 1, 2021 to March 31, 2022 ASC fee schedule, March 1, 2021 to September 30, 2021 ASC fee schedule, January 1, 2023 to present ABA billing guide, October 1, 2022 to December 31, 2022 ABA billing guide, August 1, 2022 to September 30, 2022 ABA billing guide, July 1, 2022 to present ABA fee schedule, July 1, 2021 to June 30, 2022 ABA fee schedule, July 1, 2020 to June 30, 2021 ABA fee schedule, ABA COE fee-for-service provider directory, July 1, 2022 to present Blood bank fee schedule, July 1, 2021 to June 30, 2022 Blood bank fee schedule, July 1, 2020 to June 30, 2021 Blood bank fee schedule, View all Blood Bank services fee schedules, Substance-Using Pregnant People (SUPP) program billing guide, January 1, 2022 to December 31, 2022 CUP program billing guide, October 1, 2020 to December 31, 2021 CUP women program billing guide, July 1, 2019 to September 30, 2020 CUP women program billing guide, Inpatient Prospective Payment System (IPPS), October 1, 2020 to present Childbirth education billing guide, April 1, 2019 to September 30, 2020 Childbirth education billing guide, October 1, 2017 to March 31, 2019 Childbirth education billing guide, View all childbirth education billing guides, January 1, 2007 to present Childbirth education, July 1, 2022 to present Chiropractic services billing guide, October 1, 2020 to June 30, 2022 Chiropractic services billing guide, January 1, 2020 to September 30, 2020 Chiropractic services billing guide, View all chiropractic services for children billing guides, July 1, 2022 to present Chiropractic services for children fee schedule, July 1, 2021 to June 30, 2022 Chiropractic services for children fee schedule, July 1, 2020 to June 30, 2021 Chiropractic services for children fee schedule, View all chiropractic services for children fee schedules, July 1, 2022 to present CRT products and services billing guide, January 1, 2022 to June 30, 2022 CRT products and services billing guide, October 1, 2020 to December 31, 2021 CRT products and services billing guide, July 1, 2022 to present CRT fee schedule, April 1, 2022 to June 30, 2022 CRT fee schedule, July 1, 2021 to March 31, 22 CRT fee schedule, October 1, 2022 to present Social services blanket code crosswalk, September 1, 2021 to September 30, 2022 Social services blanket codes, November 17, 2020 to August 31, 2021 Social services blanket codes, July 1, 2022 to present COVID-19 fee schedule, January 1, 2022 to June 30, 2022 COVID-19 fee schedule, July 1, 2021 to December 31, 2021 COVID-19 fee schedule, December9, 2022to present Apple Health COVID-19 vaccine policy, November 21, 2022 to December 8, 2022- Apple Health COVID - 19 vaccine policy, October 12, 2022 to November 20, 2022 Apple Health COVID-19 vaccine policy, December 16, 2022 to present Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, September 14, 2022 to December 15, 2022 Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, August 19, 2022 to September 13, 2022 Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, May 10, 2022 to August 18, 2022 Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, April 12, 2022 to May 9, 2022 Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, March 23, 2022 to April 11, 2022 Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, View all Monoclonal Antibody Treatment COVID-19 clinical policies, November 21, 2022 to present Apple Health COVID-19 testing clinical policy, March 4, 2022 to November 20, 2022 Apple Health COVID-19 testing clinical policy, January 24, 2022 to March 3, 2022 Apple Health COVID-19 testing clinical policy, View all COVID-19 testing clinical policies, Access to Baby and Child Dentistry (ABCD), January 1, 2023 to present Dental-related services program billing guide, October 1, 2022 to December 31, 2022 Dental-related services program billing guide, August 1, 2022 to September 30, 2022 Dental-related services program billing guide, July 1, 2022 to present Oral Health Connections pilot project billing guide, January 1, 2022 to June 30, 2022 Oral Health Connections pilot project billing guide, October 1, 2020 to December 31, 2021 Oral Health Connections pilot project billing guide, View all OHC pilot project billing guides, July 1, 2022 to present Mobile anesthesia for dental services billing guide, January 1, 2023 to present Dental program fee schedule, October 1, 2022 to December 31, 2022 Dental program fee schedule, July 1, 2022 to September 30, 2022 Dental program fee schedule, July 1, 2022 to present Diabetes education program billing guide, July 1, 2021 to June 30, 2022 Diabetes education program billing guide, April 1, 2021 to June 30, 2021 Diabetes education program billing guide, View all Diabetes Education Program billing guides, July 1, 2022 to present Diabetes education, July 1, 2021 to June 30, 2022 Diabetes education, July 1, 2020 to June 30, 2021 Diabetes education, View all diabetes education fee schedules, Medical Equipment and Supplies billing guide, January 1, 2019 to March 31, 2019 DME and non-CRT wheelchairs billing guide, October 1, 2018 to December 31, 2018 DME and non-CRT wheelchairs billing guide, July 1, 2018 to September 30, 2018 DME and non-CRT wheelchairs billing guide, Medical Equipment and Supplies fee schedules, January 1, 2019 to March 31, 2019 Other DME fee schedule, January 1, 2019 to March 31, 2019 Wheelchairs and accessories fee schedule, View all DME social services blanket codes, January 1, 2023 to present ESPDT program billing guide, July 1, 2022 to December 31, 2022 EPSDT program billing guide, April 1, 2022 to June 30, 2022 EPSDT program billing guide, July 1, 2022 to present EPSDT fee schedule, July 1, 2021 to June 30, 2022 EPSDT fee schedule, July 1, 2020 to June 30, 2021 EPSDT fee schedule, March 1, 2023 to present - Enteral nutrition billing guide, September 1, 2022 to February 28, 2023 Enteral nutrition billing guide, July 1, 2022 to August 31, 2022 Enteral nutrition billing guide, View all enteral nutrition billing guides, March 1, 2023 to present Enteral nutrition fee schedule, July 1, 2022 to February 28, 2023 Enteral nutrition fee schedule, July 1, 2021 to June 30, 2022 Enteral nutrition fee schedule, January 1, 2023 to present Family planning billing guide, July 1, 2022 to December 31, 2022 Family planning billing guide, February 1, 2022 to June 30, 2022 Family planning billing guide, January 1, 2023 to present Family planning fee schedule, October 1, 2022 to December 31, 2022 Family planning fee schedule, July 1, 2022 to September 30, 2022 Family planning fee schedule, July 1, 2022 to present SRHP fee schedule, October 1, 2021 to June 30, 2022 SRHP fee schedule, Physician-Related Services/Health Care Professional Services Billing Guide, Physician administered drugs fee schedule, Family planning only program telemedicine services offered during the COVID-19 outbreak, Family planning client application (form 13-781), January 1, 2023 to present FQHC billing guide, October 1, 2022 to December 31, 2022 FQHC billing guide, August 1, 2022 to September 30,2022 FQHC billing guide, January 1, 2023to present FQHC encounter rates, October 1, 2022 to December 31, 2022 FQHC encounter rates, July 1, 2022 to September 30, 2022 FQHC encounter rates, January 1, 2023 to present FQHC enhancement rates, October 1, 2022 to December 31, 2022 FQHC enhancement rates, July 1, 2022 to September 30, 2022 FQHC enhancement rates, August 1, 2022 to present Habilitative services program billing guide, July 1, 2022 to July 31, 2022 Habilitative services program billing guide, January 1, 2022 to June 30, 2022 Habilitative services program billing guide, View all habilitative services billing guides, July 1, 2022 to present Habilitative services, July 1, 2021 to June 30, 2022 Habilitative services, January 1, 2021 to June 30, 2021 Habilitative services, View all habilitative services fee schedules, April 1, 2022 to present Hearing hardware billing guide, November 1, 2020 to March 31, 2022 Hearing hardware billing guide, October 1, 2020 to October 31, 2020 Hearing hardware billing guide, July 1, 2022 to present Hearing hardware fee schedule, April 1, 2022 to June 30, 2022 Hearing hardware fee schedule, July 1, 2021 to March 30, 2022 Hearing hardware fee schedule, April 1, 2022 to present HIV/AIDS case management billing guide, April 1, 2021 to March 31, 2022 HIV/AIDS case management billing guide, October 1, 2020 to March 31, 2021 HIV/AIDS case management billing guide, July 1, 2018 to present HIV/AIDS case management, January 1, 2023 to present Home health (acute care services) billing guide, July 1, 2022 to December 31, 2022 Home health (acute care services) billing guide, April 1, 2022 to June 30, 2022 Home health (acute care services) billing guide, View all home health services billing guides, January 1, 2023 to present Home health fee schedule, July 1, 2022 to December 31, 2022 Home health fee schedule, January 1, 2022 to June 30, 2022 Home health fee schedule, View all home health services fee schedules, January 1, 2023 to present Home Infusion therapy billing guide, November 16, 2022 to December 31, 2022 Home Infusion therapy billing guide, October 1, 2021 to November 15, 2022 Home Infusion therapy billing guide, View all home infusion therapy and nutrition billing guides, January 1, 2023 to present Home infusion therapy/parenteral nutrition fee schedule, October 1, 2022 to December 31, 2022 Home infusion therapy/parenteral nutrition fee schedule, July 1, 2022 to September 30, 2022 Home infusion therapy/parenteral nutrition fee schedule, View all home infusion therapy/parenteral nutrition fee schedules, July 1, 2022 to present Hospice services billing guide, October 1, 2020 to June 30, 2022 Hospice services billing guide, January 1, 2020 to September 30, 2020 Hospice services billing guide, October 1, 2021 to September 30, 2022 Hospice fee schedule, October 1, 2020 to September 30, 2021 Hospice fee schedule, January 1, 2020 to July 1, 2020 Hospital-based inpatient detoxification billing guide, July 1, 2019 to December 31, 2019 Hospital-based inpatient detoxification billing guide, January 1, 2019 to June 30, 2019 Hospital-based inpatient detoxification billing guide, View all hospital-based inpatient detoxification billing guides, January 1, 2023 to present Inpatient hospital services billing guide, October 1, 2022 to December 31, 2022 Inpatient hospital services billing guide, July 1, 2022 to September 30, 2022 Inpatient hospital services billing guide, View all inpatient hospital billing guides, Guidance for billing MCOs for services provided to newborns, RAC Eligibility Codes for Healthy Options Blind/Disabled (HOBD) Clients, November 1, 2022 to present Interpreter services billing guide, April 1, 2022 to October 31, 2022 Interpreter services billing guide, October 1, 2021 to March 31, 2022 Interpreter services billing guide, July 1, 2022 to present Kidney center services billing guide, January 1, 2022 to June 30, 2022 Kidney center services billing guide, January 1, 2021 to December 31, 2021 Kidney center services billing guide, View all kidney center services billing guides, January 1, 2023 to present Kidney centers fee schedule, October 1, 2022 to December 31, 2022 Kidney centers fee schedule, July 1, 2022 to September 30, 2022 Kidney centers fee schedules, View all kidney center services fee schedules, July 1, 2022 to present Long-term care program billing guide, October 1, 2020 to June 30, 2022 Long-term care program billing guide, January 1, 2020 to September 30, 2020 Long-term care program billing guide, View all long-term acute care billing guides, August 1, 2022 to present MSS/ICM billing guide, July 1, 2022 to July 31, 2022 MSS/ICM billing guide, January 1, 2021 to June 30, 2022 MSS/ICM billing guide, July 1, 2020 to present MSS/ICM fee schedule, January 1, 2020 to June 30, 2020 MSS/ICM fee schedule, October 1, 2015 to December 31, 2019 MSS/ICM fee schedule, October 21, 2022 to present Medical Equipment and Supplies Billing Guide, October 1, 2022 to October 20, 2022 Medical Equipment and Supplies Billing Guide, July 1, 2022 to September 30, 2022 Medical Equipment and Supplies Billing Guide, View all Medical equipment and supplies billing guides, October 1, 2022 to present Medical Equipment and Supplies fee schedule, July 1, 2022 to September 30, 2022 Medical Equipment and Supplies fee schedule, January 1, 2022 to June 30, 2022 Medical Equipment and Supplies fee schedule, View all medical equipment and supplies fee schedules, February 17, 2023 to present - Medical nutrition therapy billing guide, August 1, 2022 to February 16, 2023 Medical nutrition therapy billing guide, July 1, 2022 to July 31, 2022 Medical nutrition therapy billing guide, View all medical nutrition therapy billing guides, July 1, 2022 to present Medical nutrition therapy fee schedule, July 1, 2021 to June 30, 2022 Medical nutrition therapy fee schedule, July 1, 2020 to June 30, 2021 Medical nutrition therapy fee schedule, View all medical nutrition therapy fee schedules, January 1, 2023 to present Mental health services billing guide, October 1, 2022 to December 31, 2022 Mental health services billing guide, August 1, 2022 to September 30, 2022 Mental health services billing guide, View all mental health services billing guides, January 1, 2023 to present Mental health and psychology services fee schedule, July 1, 2022 to December 31, 2022 Mental health and psychology services fee schedule, January 1, 2022 to June 30, 2022 Mental health and psychology services fee schedule, View all mental health services fee schedules, January 1, 2023 to present Specialized mental health fee schedule, July 1, 2022 to December 31, 2022 Specialized mental health fee schedule, January 1, 2022 to June 30, 2022 Specialized mental health fee schedule, View all specialized mental health services fee schedules.
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