Medicaid Billing Module
Nursing
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.
• Students with a Section 504 Plan are not eligible for
Medicaid Billing.
• As of August 1, 2015, ICD diagnosis codes are
required. ICD-9 codes are in effect through
September 30, 2015.
• As of October 1, 2015, ICD-10 diagnosis codes are
required.
Health Care Plan
• For all student’s receiving specialized nursing
services, a Health Care Plan is required per
WVDE Policy 2422.7
• A copy of the Health Care Plan is to be attached to
the Service Care Plan
• Specialized Nursing Services must be listed on the
student’s IEP
• Parents/guardians give consent to release
information when giving consent to bill Medicaid.
This consent allows information to be shared with
those billing for Medicaid
Student Demographics
• Complete this section taking note of the
following issues
• The diagnosis code is to be an ICD 10 code
as of October 1, 2015. An ICD-9 code was
required for services provided from August 1,
2015 through September 30, 2015.
• For provider name print the name of the
person providing the service.
Procedure Codes
• Complete beginning and end dates for each
procedure. For T1001 SE and 92950 typically
only one date is entered for beginning and end
date. If one of these codes is billed more than
once in a month list each date separately within
the space available.
• There is one line for each of the three available
procedure codes.
• 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
0000000001
Doe
Jane
WVEIS #
Diagnosis Code
Date of Birth
590000001
F44.5 Conversion disorder with seizures or convulsion
01-01-1900
County
1 Beginning Date
1 Ending Date
1 Procedure Code
Units
059
10/01/2015
10/1/2015
T1001 SE
1
School
2 Beginning Date
2 Ending Date
2 Procedure Code
Units
201
10/01/2015
10/31/2015
T1000 SE
21
Provider Name
3 Beginning Date
3 Ending Date
3 Procedure Code
Units
Melanie Smith
10/21/2015
10/21/2015
92950
1
Explanation of Procedures
and Caps Part 1
Code
Procedure
Service Unit
T1001 SE
Nursing Assessment/Evaluation.
2 events per calendar year
T1000 SE
School based/independent nursing services – licensed. Regarding the specialized healthcare
procedures summarized below
92950
Manual Resuscitator
15 minutes units. Each procedure is a
maximum of 10 units per instructional
day.
10 events per calendar year
T1017 SE
Targeted Case Management (If an appropriate Targeted Case Management service has been
provided, complete the Targeted Case Management Form).
15 minutes per 1 unit
Procedures and Caps Part 1
• There are three separate procedure codes which
can be billed on this form.
• T1001 SE (Unit = 1 event) are for up to two
Assessments per calendar year. The two types of
assessments are listed in Part 2
• T1000 SE are for direct nursing services. There
are 16 different procedures that are billable under
this code. Each of them can be provided up to 10
units per day (1 unit = 15 minutes).
• 92950 (Unit = 1 event) is a manual resuscitator
with a cap of 10 events per calendar year.
Explanation of Procedures
and Caps Part 2
Anaphylactic Reaction Evaluation (T1001 SE)
(2 Events/Calendar Year)
Seizure Management (T1001 SE)
(2 Events/Calendar Year)
Manual Resuscitator (92950)
(10/Calendar Year)
The following procedures use T1000 SE code: Each of the following procedures can be billed, with a maximum of 10 units for
each procedure per instructional day, (1 Unit = 15 minutes)
Long Term Medication Administration
Catheterization: Clean-Self-Sterile
Mechanical Ventilator
Ostomy Care: Emptying/Changing of Ostomy
Pouch
Measurement of Blood Sugar with a Glucometer
Subcutaneous Insulin Infusion Pump/Bolus
Emergency Medication Administration
Oral Suctioning
Subcutaneous Insulin by Injection
Enteral Feeding (tube feeding)
Postural Drainage and Percussion
Tracheostomy Care
Inhalation Therapy by Machine
Oxygen Administration
Peak Flow Meter
Anaphylactic Reaction Individual
Procedures and Caps Part 2
• Assessments include:
– Anaphylactic Reaction/Evaluation
– Seizure Management
Procedures and Caps Part 2
• A unit for T1000 SE is made up of 15 minutes.
Minutes from different days within the month may
be combined to create a unit.
• Units cannot be rounded up but may be combined.
• Example: it takes 5 minutes to give medication
each day. On the third day you have a total of 15
minutes which can be billed as one unit. Still
document start and stop times for the 5 minutes
on the billing form each day.
The Rights
• When determining the time spent administering medication
factor in all aspects involved when ensuring the rights:
–
–
–
–
–
–
–
–
Right patient
Right medication
Right dose
Right route
Right reason
Right time
Right result
Right documentation
• Time spent completing Medicaid paperwork IS NOT included
in the time to administer medication.
Targeted Case Management
• Nurses can also bill for Targeted Case
Management (TCM).
• These are typically indirect actions related
to the student’s medical needs.
• See the TCM billing form module for more
details.
Start and Stop Times
• Enter the start and stop times for each T1000 SE 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 you provide more than one service a day you can enter
more than one start and stop time per day. (Example student
is administered medications three times per instructional day.
List all three start times in one box and all three stop times in
one box.)
• Start and stop times are not required on this form for
assessments (T1001 SE) and manual resuscitator (92950).
• See Sample 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
Additional Documentation
• Nurse logs completed during the month for
each student must accompany the billing
form. If one continuous form is used for
services across multiple months, copy the
section for the appropriate month.
• These logs provide specific details to back
up the procedures provided to the student
during the month.
Signature and Credentials
• The RN who provided the service will sign
the form and list credentials
• RN is a required credential as only
Registered Nurses are allowed to bill for
nursing services
• RNs must be an enrolled provider
associated with the school district
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