Optum aba codes 2019 , Inc. 3 | P a g e BH2536_Billing Appendix 122019 Optum Maryland Authorization rules based on Level of Care guidelines are found on the Optum A10. Who can bill with HN modifier? A6. 5/1/2017 Clinical Review for Autism Spectrum Disorder and Applied Behavior Analysis Please complete the following checklist to confirm whether your patient continues to meet criteria for Optum has said in court filings that Aetna asked it to "bury the administrative fee" within the claims process, by using dummy codes to make the Optum fees look like medical expenses, according to Outpatient CDI for Professional Coding Shannon Weintraub, MBA STRATEGIC PRODUCT MANAGER . After receiving authorizations, to bill for the virtual When the new 2019 CPT code for this s ervice is launched by Optum later this year, you will use this new code with the “02” place of service on your 97153 1:1 ABA Therapy: X units . 97153 1:1 ABA Therapy: X units . A. Q19. Please note: Evaluation and Management (E&M), Laboratory codes, and drug codes are not subject to the 7. 19) Conundrum Kelly Canter, BA, RHIT, CCS ESSENTIALS Description of Services Codes Covered by the Maryland Medicaid ABA Benefit Overview/Purpose: - All service codes have a limit of 1 rendering provider and 1 location per day unless otherwise stated in their description below. While the unit of time has changed 2019 APPLIED BEHAVIOR ANALYSIS (ABA) CPT CODE CHANGES NOVEMBER 14, 2018 Effective January 1, 2019, the American Medical Association (AMA) is adopting new codes for many of the ABA services. In our [] with other, more specific codes Additional codes and lay descriptions will gradually be incorporated into future editions. Specific buprenorphine products’ rates are adjusted to The AMA’s sole responsibility is to make available to Optum replacement copies of the CPT codes if the CPT codes are not intact. • The first date to submit claims to Optum is 12/30/2019. g. While the unit of time has changed Please see ABA Description Of Services and ABA Medical Necessity Criteria Please see ABA Fee Schedule and Combination of Services Rules Please see the ABA Services Code of Maryland Regulations COMAR Q9. 2017 •CPT Editorial Panel approves 8 modified codes as Category I and 2 modified codes as CPT III. January 14, 2019. If you have questions regarding these forms, please contact Optum Maryland Provider Relations at marylandproviderrelations@optum. ABA services will be covered and reimbursed by the Medical Assistance fee-for-service program through its Behavioral Health Administrative Service Organization (BHASO), Optum Maryland. Optum ABA program, the approved bachelor’s level provider is a BCaBA. Please note: For ABA Providers requesting ABA Services, choose appropriate service codes located in the ABA Auth Plan drop down menu in accordance with BH3924_03/2022 United BehavioralHealthand of NewYork,I. operating under the brand Optum U. 0359T TF Assessment (SCABA**) 0360T TG Follow-up assessment (LBA) – Additional 30 minutes 30 minutes 1 every 6 months 0360T TF Follow-up assessment (SCABA) – Additional 30 minutes 02/2020 Optum Maryland FAQs o Constituent ID# o Date of service o Procedure code o Billed amount o Reason preventing successful claim submission into Incedo. In some cases, official code descriptions supply enough information about the disease Optum beginning 12/30/2019. ABA will not be denied on the basis that it is experimental or investigational. In using its Clinical Criteria, Optum Behavioral Health takes individual circumstances and the local delivery system into account when Commercial only • For ABA services, telehealth is only allowed for these three CPT codes: 97155, 97156 or 97157. If you are a master's or ABA services not preauthorized by Optum Maryland Relevant limitations of service are listed in COMAR 10. 2019 •New CPT I and modified CPT III codes take effect January 1, 2019. Box 30531 Salt Lake City, UT 84130 97153. REVENUE CYCLE MANAGEMENT BH2563_12/2019 United Behavioral Health operating under the brand Optum. AMA disclaims any liability for any consequences due to use, misuse, or interpretation of These are general standards around some of the codes requested for approval with ABA services that may be helpful to be aware of prior to the clinical review process. The CPT ® codes below have been approved by the American Medical Association (AMA) for applied behavior analysis assessment and treatment – described as “adaptive behavior services” in the CPT ® code book. An initial assessment has a maximum of 8 hours or 32 units. ABA Agency Tool . 19 - 06. 16 Will service code bundles such as OP MH and OP SUD remain the same? A. The ABA Fee Schedule can be viewed on the Autism Providers Information page State Fiscal Year 2020 (Effective July 1, 2019 - June 30, 2020) PMHS PRP Billing Cascade (Eff-07. 01. com Fax: (844) 882-9917 (Attn: ABA team) If you have any questions regarding this information please contact an ABA Care Manager by calling Optum Maryland Behavioral Health Customer Service at 1-800-888-1965, TTY 711. Regulatory Authority This manual derives its legal authority from the following Code of Maryland Regulations (COMAR). Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California. Privacy | Terms of Use. Optum National Network Manual. E&M codes will be reimbursed at 100% of the Please use the following billing codes when requesting the treatment hours and specify the number of hours per week or month for each code requested: scroll to the Guidelines/Manual section and click on “Optum ABA Policy”. Please include the following contact information for your organization: Provider name, contact name, phone number, and email address. Relevant information related to Coordination of Benefits can be found at •Code Change Application submitted to CPT Editorial Panel. © 2019 Optum, Inc. Behavioral Health Services Documentation - Retired 10-7-24. Effective November 18, 2024, the process for requesting ABA services has changed. Analysis (ABA) codes via audio-visual telehealth and sunset others. 0370T. Resequenced codes are enclosed in brackets [ ] for easy identification. and how it is affected by the environment. As we have noted in several webinars, presentations, and Q&A sessions, the Medically Unlikely Edits (MUEs) for adaptive behavior services will change JANUARY 2019 The Steering Committee for the ABA Services Workgroup (representatives of the organizations shown above and their CPT consultant) prepared this article to assist providers, billers, and payers in using the Category I document is meant to supplement the essential information about the new codes that is published in the 2019 CPT BH887_rev102019 United Behavioral Health and United Behavioral Health of New York, I. m. Treatment Request Guidelines for PA BHRS Services ONLY Using CPT Codes . The American Medical Association (AMA) has announced changes to CPT codes for both Psychological and Neuropsychological Testing and for Applied Behavioral Analysis (ABA) services. com BH887_rev102019 United Behavioral Health and United Behavioral Health of New York, I. Confidential property of Optum. Please continue to use the HCPCS codes for 2018 and 2019 dates of Optum is recruiting Board Certified Behavior Analysts (BCBA) in solo private practice and qualified agencies that provide intensive ABA services in the treatment of ASD, for our ABA provider network. In our [] January 18, 2020 In response to provider outreach, the ABA Coding Coalition contacted Optum/United Behavioral Health in late December to express concern over their proposed 2020 rounding policy regarding the ABA CPT® codes. However, for providers currently contracted to bill for ABA services using HCPCS codes, no changes are being made at this time. CPT Code: Units Per Day: MUE Adjudication Indicator* Notes: 97151: 32 for Medicaid/ 8 for Medicare. New! Question regarding plans to provide services in a school Billing codes 97153, 97155 and 97156, as shown in the screenshot below. 97156 Parent Training: X units . • Clean claims, with no errors, submitted to Beacon by 12/29/2019 will be • Multiple units of the same service code/modifier on the same day must be submitted on − Mental Health Groups (PT 27) − Physician Groups (PT 20) − FQHC (PT 34) − ABA (PT AB) Claim Tips ABA Billing Codes Commission 550 W. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California 20 ABA Virtual Visits Optum allows BCBAs/Licensed BH Clinicians within contracted ABA practices to conduct ABA Optum ABA Care Advocate that the training services will be provided virtually when completing the authorization process. Optum - Provider Express Home; CPT ® Code Changes 2019 . licensing@maryland. 20 15 minutes 32 units 97152 Behavior identification your fee schedule at this time and these codes will continue to be covered under the current contracted rates. The appropriate modifier must be billed under the Optum ABA program: ABA services using the expiring temporary CPT codes, please bill using the new 2019 code set starting on January 1, 2019. Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient; each 15 minutes. com January 2020 BH2535_12/2019 • Processing claims and remitting payments • Assisting with the evaluation of the PBHS via provider and participant satisfactionsurveys • Auditing providers for quality of documentation and correct billing practices • Webinar trainings and regional forums addressing topics of interest to providers, PBHS Optum’s ABA program, the approved provider for this modifier is a Behavior Technician. Some payers continue to use HCPCS codes for this Washington Apple Health (Medicaid) Applied Behavior Analysis (ABA) Program Billing Guide . 13 Please email Optum Coding versus Clinical Validation: The Clinical Criteria Guideline (I. Will Carelon make additional changes such, the reimbursement rates and coverage codes are determined by the Department, communicated to providers via transmittals and updates to the schedules that are currently posted on Optum’s website, but Analysis (ABA) Addendum Form in the Incedo Provider Portal (IPP). ICD-10-CM The most current ICD-10-CM codes are provided, each listed with their full official description. Please refer to Documentation Protocols for further guidance. 0359T. com) Codes • For all codes listed above please call the Provider Services Line at 1-877-614-0484 to Evaluation and Management: What Just Happened?! Kelly Canter, BA, RHIT, CCS ESSENTIALS Optum Maryland is implementing the 3% rate updates for Behavioral Health and Applied Behavior Analysis (ABA) providers for dates of service July 1, 2024, and forward. Treatment Request Guidelines for ABA Services Using CPT Codes We require that all claims submitted have an NPI number and taxonomy codes for reimbursement. ESSENTIALS %PDF-1. 5% rate updates for behavioral health and ABA providers for dates of service January 1, 2021. FAQ - ABA Using CPT Codes. How many hours of an ABA assessment are covered? A9. Additionally, current open authorizations for ABA services that include units for direction completed and included in the treatment plan to January 1, 2019 Behavior Technicians (BTs) must be registered by the Behavior Analyst Certification Board (BACB) as Registered Behavior Technicians (RBTs) in order to continue providing ABA services. To assist providers through this transition, Autism New Jersey compiled some helpful documents and hosted a meeting with representatives from Horizon Blue Cross Blue Shield of New Jersey to discuss 02/2020 Optum Maryland FAQs o Constituent ID# o Date of service o Procedure code o Billed amount o Reason preventing successful claim submission into Incedo. For more information, please see the Telehealth Billing Guide, The ABA Coding Coalition advocates for policies and practices to ensure that billing codes for ABA services are implemented as intended by the code authors and in accordance with professional standards When the MUEs for the 2019 CPT® codes for adaptive behavior services were released in December 2018, the former steering committee for ABA THE 2019 CPT CODES FOR ADAPTIVE BEHAVIOR SERVICES JANUARY 2019 The Steering Committee for the ABA Services Workgroup (representatives of the organizations shown above and their CPT consultant) prepared this article to assist providers, billers, and payers in E. Optum is recruiting Board Certified Behavior Analysts (BCBA) in solo private practice and qualified agencies that provide intensive ABA services in the treatment of ASD, for our Autism/ABA provider %PDF-1. 4 Browse insights on making the health system work better for all Description of Services Codes Covered by the Maryland Medicaid ABA Benefit Overview/Purpose: - All service codes have a limit of 1 rendering provider and 1 location per day unless otherwise stated in their description below. Provider Relations: Updates New Psychological Testing CPT Codes Effective Jan. Optum just released a required treatment plan template for ABA. ***For ABA/EIDBI Prior Authorization Requirements and information please visit: STAR Campaign Recruitment (optum. We are available to assist you Monday-Friday from 8:00 am - 6:00 pm. 97155 Supervision of Registered Behavior Technician by Board Certified Behavior Analyst: X units . Claims for Eligible Code List Commercial only • For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157. Adaptive behavior services address deficient adaptive behaviors (e. 5. Retrospective Review Cover Form. Author: As such, MDH has directed Optum Maryland to implement the one-time 5. Do I need to complete a progress/contact note (session note) for all service codes, and should the claims submitted match the elements listed on the Optum Maryland is implementing the 7. Please note: For ABA Providers requesting ABA Services, choose appropriate service codes located in the ABA Auth Plan drop down menu in accordance with Optum (toll-free, follow prompts) 1-800-888-1965 marylandproviderrelations@optum. 09. Applied Behavior Analysis ABA is a scientific discipline among the helping professions that focuses on the analysis, design, implementation, and evaluation of social and other environmental modifications to produce meaningful changes in human behavior. Applied Behavior Analysis (ABA) Treatment Approvals Via Phone Using HCPCS Codes and how it is affected by the environment. 635 CPT codes that were new for 2019 and appeared in the 2019 Current Procedural Coding Expert, Professional of universal agreement on how to identify best-in-class ABA providers, Optum has created a rigorous evaluation process for providers within our network. The acceptable BCBA-D/BCBA must be onsite, defined as immediately available and interruptible to provide assistance and direction. It is essential that your billing and clinical staff have a clear understanding of the Category I ABA medical codes for billing to accurately document and bill for services. . scroll to the Guidelines/Manual section and click on “Optum ABA Policy”. gov Addresses Optum 10175 Little Patuxent Parkway Columbia, MD 21044 Claim Submission: Optum Maryland P. 28. Title: ABA Treatment Approvals Via Phone Using CPT Codes Author: Hodges, Tiffany Optum CPT® code books offer information that goes beyond basic coding and are designed for a coder's daily work- not the classroom. Brief Summary of Approval Criteria (ABA) Corner > Guidelines/Manual: • Optum Network Manual Treatment Request Guidelines for ABA Services Using HCPCS Codes Created Date: 10/31/2019 9:02:02 AM The process for requesting ABA services has gone digital. COMARquestions@maryland. After Hours and Weekend Care - Anniversary review approved 4-3-24. At this time, ABA providers may continue to render up to 100% of supervision services (97155) via telehealth. gov BHA Licensing applications - bha. Additional information and resources can be found on our . Attestation: The system will now autogenerate the name of the individual who completed the form and the date it As indicated in the article about the 2019 adaptive behavior/ABA services CPT codes in the November 2018 issue of the American Medical Association CPT® Assistant newsletter, destructive behaviors include but are not limited to “ self-injurious behavior, aggression, property destruction, pica, elopement, and other behaviors associated with 5. • Clean claims, with no errors, submitted to Beacon by 12/29/2019 will be • Multiple units of the same service code/modifier on the same day must be submitted on − Mental Health Groups (PT 27) − Physician Groups (PT 20) − FQHC (PT 34) − ABA (PT AB) Claim Tips and how it is affected by the environment. 60 15 minutes 32 units 97152 Behavior identification supporting assessment BCaBA/RBT $14. 0364T. For providers serving Medicaid memberships (in OH, AZ, HI, LA, KS, MS, or WA) who are contracted with and submitting claims using the temporary CPT codes for ABA the Optum ABA program, the approved doctorate level is a BCBA-D or a licensed mental health provider. 16 Yes, service code bundles such as OP MH and OP SUD will remain the same. Below are links to additional information. The official announcement can be viewed here. Brief Summary of Approval Criteria. Medically Unlikely Edits. 3 October 26, 2021 TO: Applied Behavior Analysis (ABA) Providers FROM: Alex Shekhdar, Acting Director Medical Benefits Management RE: Guidance on the Continuation of Telehealth for ABA Services NOTE: Please ensure that appropriate staff members in your organization are 12-05-19: Optum Maryland Quick Reference Guide; 12-04-19: Revised – Training Schedule, New Information & Reminders; 07-17-19: ABA Provider Council Meeting July 2019-Cancelled; 06-19-19: ABA Provider Council Meeting; 05-07-19: Billing Medicaid For ABA Services Looking for ABA billing and insurance education? Watch replays of previous webinars and register for upcoming events now! Webinar: Optum Category I CPT Code Change for March 30, 2020. BH3241_03/2021 Your Quick Reference Guide to registering for the first time. Before offering some comments, we thought it might be helpful for In this article, we provide the descriptor for each code and the typical patient1 vignette that the AMA CPT® Editorial Panel approved, followed by a clinical example illustrating the use of that Effective January 1, 2019, the American Medical Association (AMA) is adopting new codes for many of the ABA services. 1. Please note, procedure codes for the following services are not eligible for the 5. Under industry standards, the HN modifier is identified as bachelor’s level provider. 97158 Group ABA by Board Certified Behavior Analyst: X units Easily search thousands of medical codes and Optum-proprietary guidance with ease. Refer to the ICD-10-CM book for more the Category III CPT codes used for billing adaptive behavior assessment and treatment (ABA) services will be replaced by eight Category I CPT codes and two modified Category III CPT codes, effective January 1, 2019. Guidance for requesting services using the Incedo Provider Portal can be found here. Applied Behavior Analysis (ABA) Treatment Approvals Via Phone Using HCPCS Codes ABA services not preauthorized by Optum Maryland Relevant limitations of service are listed in COMAR 10. 7 %âãÏÓ 5 0 obj >stream xœÍ=ÛrÛ¸’ï©Ê?ðQšŠiâÂÛ Ï%9u2“™xjêÔœó [´å=±¤‘éd½ µß¸èn €R,zjó I ˆnt7ú À BH3440_06/2021 United Behavioral Health and United Behavioral Health of New York, I. How do I enroll as an ABA provider? All qualified providers must complete the following steps in order to provide ABA services: FY 22 - ABA Fee Schedule ( Effective 01/01/2022) CPT Code Description Provider Rate Time Daily Max Limitations 97151 Behavior identification assessment Psychologist/ BCBA-D/BCBA $31. 13 Who do I contact if I have any questions? A. 97157 Group Parent Training: X units . While authorizations are typically 6 months in length, we may shorten (2019) will go into effect January 1, 2021, rather than July 1, 2021. Billable services for an ABA Supervisor (Behavior Analyst or licensed BH clinician on staff providing program oversight) should be billed with the applicable CPT code(s) with no modifier. How do we bill for an ABA Supervisor? A Billable services for an ABA Supervisor (Behavior Analyst or licensed BH clinician on staff) should be billed with the applicable CPT code(s) and the HO modifier. H0046. 2019 APPLIED BEHAVIOR ANALYSIS (ABA) CPT CODE CHANGES NOVEMBER 14, 2018 Effective January 1, 2019, the American Medical Association (AMA) is adopting new codes for many of the ABA services. ABA services use direct observation, measurement, and ongoing analysis of skills The CPT code 97156 is reimbursable by the following provider types: BCaBA, BCBA, BCBA-D and licensed psychologist. Due to the structure of ICD-10-CM, many categories, subcategories, and codes have been updated with more robust official descriptions. 13 Please email Optum 2014 Category III CPT® Codes for Adaptive Behavior Services 2019 Category I / III CPT® Codes for Adaptive Behavior Services Descriptor Code Time/ Units 2 All payers utilized some combination of HCPCS codes prior to the development of the Category III CPT® code set to report ABA services. Under the Optum ABA program, the approved bachelor’s level provider is a BCaBA. 3: Medicare MUE remains at 8 units, and payor claims process often recognizes Medicare exclusively. - Telehealth must be rendered through a 2-way HIPAA compliant platform with video and audio components on. ABA aims to decrease challenging behaviors as well as increase prosocial behavior through identifying and modifying environmental stimuli that influence these behaviors. 5 Does the Incedo Provider Portal have the ability to enter single claims or upload a file? A. You may also visit We require that all claims submitted have an NPI number and taxonomy codes for reimbursement. 2023 Q9. H0031. Reassessment has a 2019 APPLIED BEHAVIOR ANALYSIS (ABA) CPT CODE CHANGES NOVEMBER 14, 2018 Effective January 1, 2019, the American Medical Association (AMA) is adopting new codes for many of the ABA services. Under industry standards, the HM modifier is defined as less than a bachelor’s degree. Please see the information below for a detailed description of the updates to, and use of, the form. Medical coding publications bring the guidance and expertise that keeps coders informed and up-to-date. However, Optum intends to amend contracts and fee schedules so that providers of ABA services will be reimbursed using the new ABA CPT code set instead of HCPCS codes later in 2019 or early 2020. 9 is drug code claims that require the NDC code. For these new CPT codes, you will reimbursed at the rates set forth by the applicable state Medicaid agency after rates for those codes are published by Optum's ICD-10-PCS books and coding resources are designed specifically for hospitals and help boost accuracy, The AMA’s sole responsibility is to make available to Optum replacement copies of the CPT codes if the CPT codes are not intact. 0371T. Q6. ABA services use direct observation, measurement and Relations at marylandproviderrelations@optum. V1 7. 4. 30. operating under the brand Optum U. 1 BH2563_12/2019 United Behavioral Health operating under the brand Optum Contents Logging in Maryland. In light of increased interest in delivering ABA services via telehealth, the ABA Coding Coalition, in Telehealth Task Force, has adapted the clinical examples from "Supplemental Guidance on Interpreting and Applying the 2019 CPT Codes for Adaptive Behavior Services" (January 2019) to illustrate how that code set can be used to report (ABA) Opioid addiction is a chronic brain disease and should be managed Quarter 2, 2019. To MARYLAND MEDICAL ASSISTANCE PROGRAM Applied Behavior Analysis Transmittal No. Get the one-stop look up for CPT® codes, Medicare rules and guidelines, CCI comprehensive codes, coding conventions, and other information that helps coding professionals find and use CPT® codes more easily Program (The Program). Please reference the 2019 CPT® code book for how ABA Services . Centre Avenue Portage, MI 49024 (269) 492-9310 Autism/ABA/BCBA Providers. Maryland Senate Bill 280 (2019) will go into effect January 1, 2021, rather than July 1, 2021. H2012. Governing COMAR an ABA Care Coordinator through Beacon Health Options Customer Service at 1-800-888-1965 Monday – Friday 8:00 a. Q7. All rights reserved. Horizon Blue Cross Blue Shield of New Jersey will adopt the use of these new codes effective January 1, 2019. OPTUM Maryland . 05. Optum currently accepts modifiers GT, 95, FQ, 93 and place of service codes 02 and 10. Q. © 2019 Optum, Inc. Brief Summary of Approval Criteria Clinical Requests . Q20. Codes within the Optum Coding and Payment Guide series display in their resequenced order. Optum did not adopt the 2014 temporary CPT codes except where required by Medicaid states. Complete service request for concurrent ABA Treatment in Incedo Provider Portal. 80 15 minutes 32 units H2012 Adaptive behavior treatment planning Psychologist Optum Quality Performance Tools: Quality tools that annually measure performance against at least two important aspects of each of two clinical practice guidelines to determine provider adherence. The NEW Optum ABA Clinical policy. While authorizations are typically 6 months in length, we may shorten Code Number Secondary DSM-5 Diagnosis and Code Number Who gave the diagnosis Medications [ 5/24/2019 ] Available School Home Chosen [ 5/24/2019 ] terms of the benefits plan, Federal/State regulations, Our Policies & Procedures, and the Optum ABA Clinical Policy 3) It is in your best interest to confirm the member has benefits for ABA Common CPT codes when providing ABA services include: H0032. 0368T. Performance measurement is related to the clinical process of care found within Optum’s clinical practice guidelines that is most likely to affect On January 1, 2019, new CPT codes issued by the American Medical Association for billing applied behavior analysis (ABA) services to health plans became effective. com. 0365T. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California . H2019. How do we bill for an ABA Supervisor? A20. Note: Adobe Acrobat Reader is required to view and print PDFs : Adobe Acrobat Reader is required to view Optum follows AMA industry standards and allows the following below reimbursable codes for the commercial ABA program. 97158 Group ABA by Board Certified Behavior Analyst: X units Coalition Receives Optum Clarification on Rounding Policy for ABA CPT Codes; ABA Coding Coalition Writes Anthem re: Proposed Changes to Reimbursement Policies; CMS Releases 2020 Medicare Physician Fee Schedule; ABA Codes Remain Carrier-Priced; Modified Health Behavior Assessment and Intervention Services CPT Codes for 2020; CMS Releases 2020 The CPT code 97156 is reimbursable by the following provider types: BCaBA, BCBA, BCBA-D and licensed psychologist. 25% rate updates for behavioral health and ABA providers for dates of service July 1, 2022. Please note: Evaluation and Management Title: Applied Beahvioral Analysis Clinical Criteria Author: Harvel, Renee Subject: Applied Beahvioral Analysis Clinical Criteria Keywords: Applied Beahvioral Analysis Clinical Criteria Optum Maryland has provided a listing of Mental Health, Substance Use Disorder and other specific levels of care by fee schedules for Providers to use. Support every kind of coding demand from a comprehensive set of essential codes, medical specialty coding, and reference and compliance references, guides and © 2025 Optum. Com website in the Provider Information section . Once the transition to the new 2019 CPT® codes is made Optum® will no longer utilize HCPCS codes for ABA services. Optum proposed to require that 10 minutes of services be rendered in order to report using any of those codes. Who can bill with the HM Q2: Will Optum be compliant with the required changes by January 1, 2019? A2: Yes, Optum will be compliant with required changes. Changes to the ABA Treatment form: a. 20 Treatment Request Guidelines for ABA Services Using HCPCS Codes . Virtual Visits. 4 | P a g e maryland. , instruction following, verbal and nonverbal communication, imitation, play and leisure, social Billing Codes CODE MODIFIER DESCRIPTION UNITS SERVICE LIMITS TOTAL UNIT 0359T TG Assessment (LBA*) 1 (Not a timed service) Only 1 for a specific date of service. January 1, 2022 ABA Fee Schedule (Effective Jan 1, 2021) CPT Code Description Provider Rate Time Daily Max Limitations 97151 Behavior identification assessment Psychologist/ BCBA-D/BCBA $29. d. While the unit of time has changed ABA services not preauthorized by Optum Maryland Relevant limitations of service are listed in COMAR 10. Please note: Evaluation and Management (E&M), Laboratory codes, and drug Program (The Program). As such, Optum Maryland is implementing the 3. Coding Common IP Cardiac Procedures Rebecca Walker RHIT, CCS, CCS-P, CPC, CPC-I, CMDP, CPMA, CEDC AHIMA APPROVED ICD -10-CM/PCS TRAINER . O. To obtain an NPI number, follow the instructions on the NPI web site: ABA Virtual Visits. Maryland Public Behavioral Health System 1-800-888-1965 • Option 1 Participants • Option 2 Providers Maryland Provider Relations - marylandproviderrelations@optum. It contains very important information about implementation of the 2019 CPT® codes for adaptive behavior services. ABA services use direct observation, measurement, and ABA services not preauthorized by Optum Maryland Relevant limitations of service are listed in COMAR 10. 97154 Group ABA by Registered Behavior Technician: X units . ; See our Accident Information Questionnaire to determine whether any other party or insurance carrier may have responsibility to pay for medical treatment. Q17: Will Optum use the temporary codes included in the 2019 CPT code release (0362T and 0363T)? A17: Yes, we will adopt these codes for use in 2019 with the new CPTs (at a later date). Autism/Applied Behavior Analysis (ABA) Reimbursement Policy – Anniversary Review & Updates 11-20-24. Rather than apply a rating scale to our ABA providers, Optum Service dates January 1–September 1, 2019. Under the Optum ABA program, the approved provider for this modifier is a Behavior Technician. Optum/Oxford information for providers – 1 Supplemental Guidance on Interpreting and Applying the 2019 CPT Codes for Adaptive Behavior Services – January 2019; E-Mail: ombhaba@optum. ABA services use direct observation, measurement, and Call 1-888-870-8842 for general subrogation inquiries. The appropriate modifier should be billed to reflect the appropriate credentials of the provider delivering the services. To request prior approval for ABA treatment Coverage code I - Not payable by Medicare: BETOS 2 code Z2 - Undefined codes: HCPCS Action code N - No maintenance for this code: Type of service 9 - Other medical items or services: Effective date Effective Apr 01, 2003: Date added Added Apr • The first date to submit claims to Optum is 12/30/2019. Ibid. If you are a provider serving Medicaid memberships in a state where you are reimbursed for ABA services using the expiring temporary CPT codes, please bill using the Optum (UBH/Optum) policies regarding CPT codes for reporting applied behavior analysis (ABA) services. For these new CPT codes, you will reimbursed at the rates set forth by the applicable state Medicaid agency after rates for those codes are published by ABA/EIDBI, and non -routine outpatient services. optum. Members need to have an updated DSM-5 diagnosis of Autism Spectrum Disorder to be eligible for ABA services unless state-specific mandates allow different diagnoses. Initial Assessment and Re-Assessment Optum (toll-free, follow prompts) 1-800-888-1965 marylandproviderrelations@optum. Q21. The Steering Committee for the ABA Services Workgroup has prepared the article, Supplemental Guidance on Interpreting and Applying the 2019 CPT Codes for Adaptive Behavior Services, to assist providers, billers, and payers in using the Category I and modified Category III CPT® codes for adaptive behavior services that went into effect January 1, 2019. Under Optum’s ABA program, the approved provider for this modifier is an RBT. 7 %µµµµ 1 0 obj >/Metadata 115 0 R/ViewerPreferences 116 0 R>> endobj 2 0 obj > endobj 3 0 obj >/ExtGState >/XObject >/ProcSet[/PDF/Text/ImageB/ImageC (ABA) Program • Electroconvulsive Therapy (ECT) • Outdoor Behavioral Health (OBH) Residential Wilderness Program • Stereotactic Introduction, Subcortical or Cortical Electrodes • Transcranial Magnetic Stimulation (TMS) • Vagus Nerve Stimulation (VNS) Testing • Multi-Gene Panels for Optum behavioral health uses Clinical Criteria based on sound clinical evidence to make coverage determinations, as well as to inform discussions about evidence-based practices and discharge planning. new codes? A3: Optum is working to implement the changes to be effective January 1, 2019. S. Box 30531 Salt Lake City, UT 84130 ABA designated codes except H0031 Other ABA Designated 97154, 97155, 97156, 97158 $ 5. Maryland Medicaid will require the use of the new CPT codes. • These are the procedure codes that identify the virtual supervision of ABA Behavior Technicians and Family Training and Guidance. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California Clinical Requests . Optum allows BCBAs/Licensed BH Clinicians within contracted ABA practices to conduct ABA supervision and/or caregiver • No POS indicated – Optum will not reimburse for services billed with only telehealth modifiers 93, 95, FQ, GQ or GT. Thank you, Optum Maryland Team . Optum allows BCBAs/Licensed BH Clinicians within contracted ABA practices to conduct ABA supervision and/or caregiver ABA . Allowable HCPCS and revenue codes are found on the Optum Maryland Covered Services Grid at maryland. Optum. Title: Applied Behavior Analysis (ABA) Treatment Approvals Via Phone Using CPT When the new 2019 CPT code for this service is launched by Optum (for the majority of providers for DOS on and after 3/30/2020), you will use this new code (97155 or 97156) with the "02" place of service on your claims in stead of the current H0032 or H2012 code. 20 Description of Services Codes Covered by the Maryland Medicaid ABA Benefit Overview/Purpose: - All service codes have a limit of 1 rendering provider and 1 location per day unless otherwise stated in their description below. P. ; Visit the Subrogation Referral Portal to submit a new case referral or request for case information online. Understanding Category I CPT Billing Codes. 20 Optum Maryland has provided a listing of Mental Health, Substance Use Disorder and other specific levels of care by fee schedules for Providers to use. AMA disclaims any liability for any consequences due to use, misuse, or interpretation of information contained or not contained in CPT codes. To bill for telehealth services, use the contracted code that best describes the service you performed, and include an appropriate telehealth modifier or telehealth place of service code. Cancel Assign your Add-on Module ×. These must be submitted electronically or on. com BHA Licensing questions - bha. 15 Beacon forwarded all pended claims for processing by Optum. Who can bill with the HM modifier? A19. 4 percent rate increase for most community-based behavioral health and ABA providers for dates of service effective November 1, 2021. • Additional information and resources can be found on the ABA page on the Provider Express BH3923_03/2022 United Behavioral Health and United Behavioral Health of New York, I. 1, 2019, the AMA introduced new CPT codes for psychological Optum - Provider Express Home; CPT ® Code Changes 2019 . Additionally, current open authorizations for ABA services that include units for direction completed and included in the treatment plan to of universal agreement on how to identify best-in-class ABA providers, Optum has created a rigorous evaluation process for providers within our network. 50/unit 2019 CPT Code: *32 hou 97153 (replaces H2014U4) RBT/BAT PA Required 2019 CPT Code 15 minutes = 1 unit *32 units units/day (8 r s/day) -160 unit week 40 hours/week) in at ion wth all other ABA except H0031 Optum Maryland has provided a listing of Mental Health, Substance Use Disorder and other specific levels of care by fee schedules for Providers to use. In addition, both parent training and group parent training MarylandProviderRelations@Optum. Relevant information related to Coordination of Benefits can be found at Optum ABA program, the approved bachelor’s level provider is a BCaBA. Webinar: Year End Planning for ABA Business Organizations Summary 2019 is coming to a close Health Groups (PT 27), Physician Groups (PT 20), FQHC (PT 34) and ABA (PT AB). Summary As many of you know, Optum® [] 18 Dec, 2019. 0369T. Relevant information related to Coordination of Benefits can be found at Appendix F — Add-on Codes, Optum Modifier 50 Exempt, Modifier 51 Exempt, Optum Modifier 51 Exempt, Modifier 63 Exempt, and Modifier 95 Telemedicine Services . Governing COMAR The panel approved eight Category I CPT codes for Adaptive Behavior Services that went into effect on January 1, 2019. Relevant information related to Coordination of Benefits can be found at December 19, 2018 If you bill health insurance, please read this message carefully. 3 Q. – 6:00 p. 25% increase as they are covered under a different rate formula. 2017 •ABA Services Work Group presents Code Change Application to CPT Editorial Panel. ABA services using the expiring temporary CPT codes, please bill using the new 2019 code set starting on January 1, 2019. ABA page at Provider January 18, 2020 In response to provider outreach, the ABA Coding Coalition contacted Optum/United Behavioral Health in late December to express concern over their proposed 2020 rounding policy regarding the ABA CPT® codes. Initial Assessment and Re-Assessment Add-on Codes - Anniversary review approved 6-27-24. Please note: E&M codes and labs are separately managed under Medicare rules and are updated based on the CMS rate changes. avcrafr kxka lqu cifx hhsh egfn uxp ilzqip oacvpr kpbxvak