For those of you in the Medicaid business (or those interested) do you regularly use the online fee lookup (ONF) tool? Link: http://public.tmhp.com/FeeSchedules/Default.aspx.
Beyond just fees, this tool seems like a bit of a magic wand re. listing relevant modifiers and directing users to relevant portions of the Medicaid manual.
Examples of usefulness:
Example 1 -- 45 min. psychotherapy by a LCSW:
Tool will give you this info.:
Beyond just fees, this tool seems like a bit of a magic wand re. listing relevant modifiers and directing users to relevant portions of the Medicaid manual.
Examples of usefulness:
Example 1 -- 45 min. psychotherapy by a LCSW:
- Go to link: http://public.tmhp.com/FeeSchedules/Default.aspx.
- Click on "fee search" in the left margin.
- Enter CPT code "90834" (Psychotherapy, 45 minutes with patient and/or family member)
- Enter program "Medicaid"
- Enter Date of Service: 9/14/15
- Enter Supplier "Medical supplier (durable medical equipment [DME]); licensed clinical social worker (LCSW)" (yes... LCSWs are alphabetized under Medical suppliers/DME -- perhaps because social workers in hospital settings often perform those functions of helping patients get a cane/wheelchair, etc. -- and other examples of DME, but of course LCSWs provide a much wider scope of services including psychotherapy, and the Texas Chapter of the National Association of Social Workers has asked for LCSWs not to be listed under DME.)
- Enter provider specialty: "Licensed clinical social worker"
- Click "Submit"
Tool will give you this info.:
This tells you that the service is indeed billable for credentialed LCSWs, what the rates are based on the age of the client served, and additionally (and importantly) links to "benefit information." In the live tool, you can click on the links under "benefit information," to be directed to the most recent Medicaid manual that discusses the regulations for billing on that code!, which we expect will be very helpful to many who have felt it challenging to find the most up-to-date information and regulations.
Example 2 -- HCPCS 2015 Code : G9012 : Other specified case management service not elsewhere classified, provided by a licensed case manager in a children and pregnant women case management program. (Please reference the Volume 2: Behavioral Health, Rehabilitation, and Case Management Services Handbook for more information on this type of service.)
- Go to link: http://public.tmhp.com/FeeSchedules/Default.aspx.
- Click on "fee search" in the left margin.
- Enter HCPCS Code "G9012" (Other specified case management service not elsewhere classified)
- Enter program "Medicaid"
- Enter Date of Service: 9/14/15
- Enter Supplier "Case Management/HCBS Provider"
- Enter provider specialty: "Maternity Service Clinic (MSC)/Children and Pregnant Women Case Management"
- Click "Submit"
- You get this -- which is very helpful re. modifiers:
Then click "View" under "Benefit Information" and you are directed to the specific, relevant part of the provider manual! Where you can find out exactly what those modifiers mean...
Provider Manuals
Volume 2: Behavioral Health, Rehabilitation, and Case Management Services Handbook1/1/0001
The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Provider Handbooks August 2015 Behavioral ...
http://www.tmhp.com/TMPPM/TMPPM_Living_Manual_Current/Vol2_Behavioral_Health_Handbook.pdf - 1MB
Item Details
Provider Manuals
Volume 2: Behavioral Health, Rehabilitation, and Case Management Services Handbook1/1/0001
The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Provider Handbooks August 2015 Behavioral ...
http://www.tmhp.com/TMPPM/TMPPM_Living_Manual_Current/Vol2_Behavioral_Health_Handbook.pdf - 1MB
Item Details
Example 3 -- Lastly, you will be told if you have input a code that is not billable. For example -- this is what you get if you try to see what the reimbursement is for an LCSW to provide a 45 min. medical (evaluation and management code or E&M code) "+90836". The tool will correctly tell you this is not billable --
In summary, the uses of this tool:
- look-up reimbursement rates for current services or for prospective new business
- become more familiar with certain codes, and be corrected when they are not billable
- identify acceptable modifiers
- be directed to exact parts of the provider manual
Thanks for reading! We hope you find the online fee lookup (ONF) tool useful: http://public.tmhp.com/FeeSchedules/Default.aspx.