Section 471-14-005 - BILLING AND PAYMENT FOR OCCUPATIONAL THERAPY OR PHYSICAL THERAPY SERVICES005.01BILLING.005.01(A)GENERAL BILLING REQUIREMENTS. Providers must comply with all applicable billing requirements codified in 471 NAC 3. In the event that individual billing requirements in 471 NAC 3 conflict with billing requirements outlined in this 471 NAC 14, the individual billing requirements in 471 NAC 14 will govern.005.01(B)SPECIFIC BILLING REQUIREMENTS.005.01(B)(i)BILLING INSTRUCTIONS. The provider must bill the Department using the appropriate claim form or electronic format.005.01(B)(ii)USUAL AND CUSTOMARY CHARGE. The provider or the provider's authorized agent must submit the provider's usual and customary charge for each procedure code listed on the claim. Healthcare Common Procedure Coding System (HCPCS) procedure codes used by Medicaid are listed in the Nebraska Medicaid Practitioner Fee Schedule. 005.01(B)(iii)MEDICAL NECESSITY DOCUMENTATION. The provider must provide the following information when submitting a claim for occupational therapy (OT) or physical therapy (PT) services: (1) Date of illness or injury onset;(2) Date occupational therapy or physical therapy plan established;(3) Date occupational therapy or physical therapy started; and(4) Number of occupational therapy or physical therapy visits from onset.005.02PAYMENT.005.02(A)GENERAL PAYMENT REQUIREMENTS. The Department will reimburse the Provider for services rendered in accordance with the applicable payment regulations codified in 471 NAC 3. In the event that individual payment regulations in 471 NAC 3 conflict with payment regulations outlined in this 471 NAC 14, the individual payment regulations in 471 NAC 14 will govern.005.02(B)SPECIFIC PAYMENT REQUIREMENTS.005.02(B)(i)PAYMENT FOR INDIVIDUAL PROVIDERS. The Department pays for covered occupational therapy (OT) or physical therapy (PT) services at the lower of:(1) The provider's submitted charge; or(2) The allowable amount for that Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) procedure code in the Nebraska Medicaid Practitioner Fee Schedule in effect on the date that the service was rendered.471 Neb. Admin. Code, ch. 14, § 005
Amended effective 6/10/2020