Section 471-23-005 - BILLING AND PAYMENT FOR SPEECH PATHOLOGY AND AUDIOLOGY 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 23, the individual billing requirements in 471 NAC 23 will govern.005.01(B)SPECIFIC BILLING REQUIREMENTS.005.01(B)(i)BILLING INSTRUCTIONS. The Provider must bill Nebraska Medicaid, using the appropriate claim form or electronic format. 005.01(B)(ii)USUAL AND CUSTOMARY CHARGE. The provider, or their authorized agent, must submit the provider's usual and customary charge for services rendered. 005.01(B)(iii)MEDICAL NECESSITY DOCUMENTATION. The provider must list the following information when submitting a claim for speech pathology or audiology services: (1) Date of illness or injury onset:(2) Date speech pathology or audiology plan established:(3) Date speech pathology or audiology started; and(4) Number of speech pathology or audiology visits from onset.005.02PAYMENT.005.02(A)GENERAL PAYMENT REQUIREMENTS. Nebraska Medicaid 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 chapter, the individual payment regulations in this chapter will govern.005.02(B)SPECIFIC PAYMENT REQUIREMENTS.005.02(B)(i)PAYMENT FOR INDIVIDUAL PROVIDERS. Nebrasaka Medicaid pays for covered speech pathology and audiology services in the amount equal to the lesser of:(1) The provider's submitted charge; or (2) The allowable amount for that procedure code in the Nebraska Medicaid Practitioner Fee Schedule in effect for that date of service.471 Neb. Admin. Code, ch. 23, § 005
Amended effective 12/26/2021