Medicaid Billing Module
Occupational Therapy
Billing Form
Changes
• Services must be documented on the current IEP for
meetings held prior to August 1, 2015.
• Services must be documented on Service Care Plan for IEP
meetings held after August 1, 2015.
• As of August 1, 2015 OT specific ICD diagnosis codes are
required. ICD-9 codes are in effect through September 30,
2015. ICD codes must relate to the specific type of therapy
being provided. A global code such as Cerebral Palsy would
not be sufficient.
• As of October 1, 2015 OT specific ICD-10 diagnosis codes
are required. Think of these more as treating diagnosis
codes.
Physician Authorization
• Physician Authorization is still required annually to
bill for occupational therapy.
• OT suggested ICD-10 diagnosis (treating) code
should be included on this form. When the
Physician signs the form they are also confirming
the therapist’s code(s).
• Authorization can now be from a Physician's
Assistant or an Advanced Practice Registered
Nurse (APRN).
• Authorization is good for one calendar year from
the date signed.
Student Demographics
• Complete this section taking note of the
following issues
• The diagnosis code is to be an ICD 10
code that matches the need for
occupational therapy.
• For provider name print the name of the
person providing the service.
Procedure Codes
• Complete beginning and end dates for
each procedure.
• List the total number of units for the month
for each procedure.
• The form is to be used for only one month.
Student Demographics
and Procedures Sample
Medicaid Number
Last Name
First Name
0000000000
Doe
Jane
WVEIS #
Diagnosis Code
Date of Birth
999999999
01-01-1900
County
1 Beginning Date
1 Ending Date
1 Procedure Code
Units
059
09/01/2015
09/30/2015
97110 GO
10
School
2 Beginning Date
2 Ending Date
2 Procedure Code
Units
203
09/01/2015
09/30/2015
97116 GO
5
Provider Name
3 Beginning Date
3 Ending Date
3 Procedure Code
Units
09/01/2015
09/30/2015
97002 GO
1
Explanation of Procedures
and Caps Part 1
97003 GO
Occupational Therapy Evaluation
1 event per calendar year
97004 GO
Occupational Therapy Re-evaluation
2 events per calendar year
97032 GO
Application of a modality to one or more areas; electrical stimulation (manual),
each 15 minutes
20 units per month
97110 GO
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises
to develop strength and endurance, range of motion and flexibility each 15 minutes
20 units per month
97112 GO
Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense,
posture, and proprioception for sitting and/or standing activities, each 15 minutes
20 units per month
97113 GO
Aquatic Therapy with therapeutic exercises, each 15 minutes
20 units per month
Explanation of Procedures
and Caps Part 2
97116 GO
Gait training (includes stair climbing) each 15 minutes
20 units per month
97150 GO
Therapeutic procedure(s), group (2 or more individuals), each 15 minutes.
20 units per month
97140 GO
Manual therapy techniques (mobilization/manipulation, manual lymphatic drainage,
manual traction), one or more regions each 15 minutes
20 units per month
97530 GO
Therapeutic activities, direct (one-on-one) patient contact by the provider (use of
dynamic activities to improve functional performance) each 15 minutes
20 units per month
97532 GO
Development of cognitive skills to improve attention, memory, problem solving,
(includes compensatory training), direct (one-on-one) patient contact by the provider
each 15 minutes
20 units per month
97533 GO
Sensory integrative techniques to enhance sensory processing and promote adaptive
responses to environmental demands, direct (one-on-one) patient contact by the
provider, each 15 minutes
20 units per month
Start and Stop Times
• Enter the start and stop times for each service on
the corresponding date at the bottom of the form.
• These will be used to easily identify dates billable
services were conducted for students with
transportation services.
• If provide multiple procedure codes within a
session or day, each procedure code needs to
have a separate start and stop time. See the OT
sample form for an example of how to document
on the form.
Start and Stop Times
Date
Start
Time
End
Time
1
Date
Start
Time
End
Time
16
2
17
3
4
5
6
18
19
20
21
7
22
8
23
9
24
10
25
11
26
27
12
28
13
29
14
30
15
31
Certified Occupational Therapy
Assistant (COTA)
• COTAs can only bill for therapy and when
a Occupational Therapist (OT) certified by
the WV Board of Examiners is directly
supervising.
• Directly supervising requires the Board
Certified OT to be on site when the
therapy is being provided.
• COTAs can not bill for evaluations.
Additional Documentation
• Progress/therapy logs will also be required.
• Original copies of progress/therapy logs must
be on file in the special education central
office.
• COTA progress/therapy logs are to be cosigned by the supervising OT for therapy
dates that are billed for Medicaid
• There is not a required form for
documentation of progress/therapy logs.
Signature and Credentials
• Staff who provided the service will sign the
form and list credentials.
• For COTAs, the supervising OT must cosign the billing form.
Terry Riley – Coordinator
Office of Special Education
tjriley@k12.wv.us
304-957-9833 ext 53223
WVDE Medicaid Website:
http://wvde.state.wv.us/osp/medicaid.html