December 2016
Providers,
Aetna would like to remind providers of the Ohio Medicaid administrative codes and billing practices when billing for certain services. Proper billing consistent with Ohio Medicaid rules is critical. The services below should be billed on a single claim line per visit. The practice of batching units weekly, bi weekly, monthly, etc. and submitting on a single claim line is improper per the rule.
 
Here is a generic example :
Provided the following services from Monday to Wednesday this week:
T1019 visit  on Monday at 8am-12 pm 
T1019 visit  also on Monday from 4pm to 8pm
G0299 visit on Tuesday 12 pm-4pm  
G0299 visit Wednesday 12-4pm
 
Proper Billing Practice
Claim line 1 - T1019, 16 units
Claim line 2 - T1019 U2, 16 units
Claim line 3 - G0299, 16 units
Claim line 4 - G0299, 16 units


Improper Billing Practice
Claim line 1 - T1019, 32 units
Claim line 2 - G0299, 32 units
 
 (This billing is improper because
     it fails to capture the visits properly
     as well as bundling the units onto one
     claim line)
Codes
  • State Plan Home Health Nurse - G0299, G0300
  • State Plan Home Health Aid - G0156
  • State Plan PT - G0151
  • State Plan OT - G0152
  • State Plan ST - G0153
  • PDN - T1000
  • Waiver Nursing by RN - T1002
  • Waiver Nursing by LPN - T1003
  • Waiver Personal Care Aide - T1019
Modifier Description Requirement

U1 - Infusion therapy: Must be used when code T1000 or T1002 is used for the purpose of home infusion therapy

 

U2 - Second visit: Must be used to identify the second visit for the same type of service made by a provider on a date of service per consumer.

 

U3 - Third visit or more: Must be used to identify the third or more visit for the same type of service made by a provider on a date of service per consumer.

 

U4 - 12 hours to 16 hours per visit: Must be used when a visit is more than 12 hours, but does not exceed 16 hours.

 

U5 - Healthchek: Must be used to identify consumer receiving increased services due to Healthchek in accordance to rule OAC 5160-12-02.

 

HQ - Group Visit: Must be used to identify consumer receiving services in a group setting.


 
Please see additional resource links for more information:

Ohio Department of Medicaid 's Nurse & Aide Service Rate Modernization ( http://medicaid.test.ohio.gov/Portals/0/Providers/rate-changes-2015.pdf ) Effective 7/1/2015
 
http://codes.ohio.gov/oac/5160-12-05    - Home Health G code specific
See Appendix A of OAC 5160-12-05 for ODM codes and billing rates for home health service(s) provided on and after July 1, 2015.
See Appendix B of OAC 5160-12-05 for home health service visit modifiers effective July 1, 2015.
 
http://codes.ohio.gov/oac/5160-46-06      OAC Rule specific to the waiver rates T1002, T1003, and T1019
 
http://codes.ohio.gov/oac/5160-12-06    OAC Rule specific to PDN services
 
 
If you have questions regarding this matter please reach out to the Provider Services line at 1-855-364-0974 and a Provider Services Representative can assist you, or if needed, arrangements for a Provider Relations Liaison can reach out to you directly and schedule an in-person visit if you would like.

Sincerely,
 
Provider Services
Aetna Better Health of Ohio



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