Beginning 8/1/22, Florida Medicaid is transitioning from using H codes for billing ABA services to using 9 codes. Read below for more information on recommendations on updating your codes in Rethink. *Rethink does not provide billing or coding training, but is offering this guide on system features that allow for updating your system to meet the new updates for Florida Medicaid.
Topic
Visual Support
Helpful Information
Topic
Visual Support
Helpful Information
Step 1: Inactivating Billing Codes:
On the Funder page, under your Medicaid funder, check the ‘Inactive’ boxes next to the codes that you wish to inactivate
Inactivating codes does NOT remove these codes from client authorizations nor does it prevent scheduling against clients with Active current authorizations with these codes.
Inactivating the codes at the funder level prevents adding these codes to NEW authorizations moving forward.
Step 2: Adding New Service Names, if needed:
Ensure that you have the adequate service names on your Service Lines Page in Rethink
Click “+Service” to add additional Service names
On the popup, add the Service Name and a Base Rate, click ‘Save’
We recommend adding service names for the following services, if needed: Behavior Treatment under Concurrent Supervision, Protocol Modification under Concurrent Supervision, Group Service with 2 clients, Group Service with 3 clients, & so on through 6 clients and the same for Group Protocol Modification
Step 3a: Adding New Billing Codes to the Funder:
Under the relevant Fl Medicaid funder, Click the “+” sign to add billing codes
On the popup, add your billing code, rounding rules & credentials
Click ‘Save’
Please review your specific funder contract, but at this time, Florida Medicaid codes may include the following:
97151 (Assessment and Reassessment-w/TS modifier), see screenshot to the left
97152 (Supporting Assessment),
97153 (Behavior Treatment by Protocol),
97153 XP (Behavior Treatment by protocol under concurrent supervision) This is a non-reimbursable code BUT must still be submitted to Medicaid
97155 (Behavior Treatment with protocol modification) with or without HN modifier (BCBA or BCaBA)
97155 XP (Behavior treatment with protocol modification under concurrent supervision) This is a non-reimbursable code for a Supervisee ONLY, BUT must still be submitted to Medicaid (Supervisor would use 97155 or 97155 HN for their overlapping time)
97156 (Family Training) with or without the GT modifier for telehealth
97154 UN (Group BA service, two clients in group)
97154 UP (Group BA service, three clients in group)
97154 UQ (Group BA service, four clients in group)
97154 UR (Group BA service, five clients in group)
97154 US (Group BA service, six clients in group)
97158 UN (Group BA service with protocol modification, two clients in group)
97158 UP (Group BA service with protocol modification, three clients in group)
97158 UQ (Group BA service with protocol modification, four clients in group)
97158 UR (Group BA service with protocol modification, five clients in group)
97158 US (Group BA service with protocol modification, six clients in group)
Step 3b: Adding New Billing Codes to the Funder:
Add 97155 and 97156 without a modifier(BCBA) and with the HN modifier(BCaBA)
Also, add the option for the Telehealth modifier (GT) for 97156
Telehealth modifiers are added to the billing code and then are selected by the Service Description at the scheduling level:
Scheduling:
Step 3c: Adding New Billing Codes to the Funder:
Add 97153 XP and 97155 XP as separate services that do NOT require an authorization by checking the box at the top of the popup.
Select a rendering provider-”Provider Assigned to Appointment” is recommended for Florida Medicaid.
Enter all other required fields and click ‘save’
97153 XP (Behavior Treatment by protocol under concurrent supervision) This is a non-reimbursable code BUT must still be submitted to Medicaid
97155 XP (Behavior treatment with protocol modification under concurrent supervision) This is a non-reimbursable code for a Supervisee ONLY, BUT must still be submitted to Medicaid (Supervisor would use 97155 or 97155 HN for their overlapping time)
Adding these services separately as not requiring an authorization will allow these services to be scheduled without pulling from the clients' authorizations.
If you are a Kareo user, please note that $0 rates will not upload to Kareo, so you will want to ensure that you have entered a rate of greater than $0 for each service on your funder set up in Rethink.
Step 3d: Adding New Billing Codes to the Funder:
Add Group Services as each a separate service [97154 UN (Group BA service, two clients in group); 97154 UP (Group BA service, three clients in group); 97154 UQ (Group BA service, four clients in group); 97154 UR (Group BA service, five clients in group); 97154 US (Group BA service, six clients in group); 97158 UN (Group BA service with protocol modification, two clients in group); 97158 UP (Group BA service with protocol modification, three clients in group); 97158 UQ (Group BA service with protocol modification, four clients in group); 97158 UR (Group BA service with protocol modification, five clients in group); 97158 US (Group BA service with protocol modification, six clients in group) ]
Rethink only allows up to 4 modifiers per billing code, so adding these Group services (97154 & 97158) as separate service names and billing codes based on group size & modifier is necessary.
Step 4: Adding new authorizations for the new 9 Codes:
