Reimbursement Rate Changes for Texas Medicaid Therapy Assistant Services to become Effective September 1, 2018

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1 Reimbursement Rate Changes for Texas Medicaid Therapy Assistant Services to become Effective September 1, 2018 Information posted July 11, 2018 Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. Effective for dates of service on or after September 1, 2018, services rendered by a therapy assistant (billed with modifier UB) will be reimbursed at 70 percent of the rate paid to a licensed therapist. The table below contains updated reimbursement rates for therapy assistants. Reimbursement rates for licensed therapists will not change. For additional information related to the Medical Policy for therapy services, providers can reference the notification titled "Physical, Occupational, and Speech Therapy Benefits for All s to Change for Texas Medicaid September 1, 2017," which was published on this website on June 30, For more information, providers may refer to the reimbursement rates on the HHSC rate analysis web page at legacy-hhsc.hhsc.state.tx.us/rad/rate-packets.shtml. For more information, call the TMHP Contact Center at

2 UB UB UB UB UB UB UB 0-20 Independent Therapists $91.61 $91.61 $75.45 $75.45 Independent Therapists $91.61 $91.61 $75.45 $75.45 Independent Therapists $38.70 $38.70 $31.87 $31.87 Independent Therapists $38.70 $38.70 $31.87 $31.87 Independent Therapists $ $ $90.54 $90.54 Independent Therapists $ $ $90.54 $90.54 Independent Therapists $14.03 $14.03 $11.56 $11.56 Independent Therapists $14.03 $14.03 $11.56 $ UB C UB 0-20 HHA $14.03 $14.03 $11.56 $11.56 C UB HHA $14.03 $14.03 $11.56 $ UB 0-20 Independent Therapists $13.73 $13.73 $11.31 $ UB Independent Therapists $13.73 $13.73 $11.31 $11.31 C UB 0-20 HHA $13.73 $13.73 $11.31 $11.31 C UB HHA $13.73 $13.73 $11.31 $ UB 0-20 Independent Therapists $16.78 $16.78 $13.82 $ UB Independent Therapists $16.78 $16.78 $13.82 $13.82 C UB 0-20 HHA $16.78 $16.78 $13.82 $13.82 C UB HHA $16.78 $16.78 $13.82 $ UB 0-20 Independent Therapists $9.46 $9.46 $7.79 $ UB Independent Therapists $9.46 $9.46 $7.79 $7.79 C UB 0-20 HHA $9.46 $9.46 $7.79 $7.79 C UB HHA $9.46 $9.46 $7.79 $ UB 0-20 Independent Therapists $20.44 $20.44 $16.84 $ UB Independent Therapists $20.44 $20.44 $16.84 $16.84 C UB 0-20 HHA $20.44 $20.44 $16.84 $16.84 C UB HHA $20.44 $20.44 $16.84 $ UB 0-20 Independent Therapists $5.80 $5.80 $4.77 $ UB Independent Therapists $5.80 $5.80 $4.77 $4.77 C UB 0-20 HHA $5.80 $5.80 $4.77 $4.77 C UB HHA $5.80 $5.80 $4.77 $4.77

3 UB 0-20 Independent Therapists $5.19 $5.19 $4.27 $ UB Independent Therapists $5.19 $5.19 $4.27 $4.27 C UB 0-20 HHA $5.19 $5.19 $4.27 $4.27 C UB HHA $5.19 $5.19 $4.27 $ UB 0-20 Independent Therapists $6.41 $6.41 $5.28 $ UB Independent Therapists $6.41 $6.41 $5.28 $5.28 C UB 0-20 HHA $6.41 $6.41 $5.28 $5.28 C UB HHA $6.41 $6.41 $5.28 $ UB 0-20 Independent Therapists $31.51 $31.51 $25.95 $ UB Independent Therapists $31.51 $31.51 $25.95 $25.95 C UB 0-20 HHA $31.51 $31.51 $25.95 $25.95 C UB HHA $31.51 $31.51 $25.95 $ UB 0-20 Independent Therapists $30.00 $30.00 $24.70 $ UB Independent Therapists $30.00 $30.00 $24.70 $24.70 C UB 0-20 HHA $30.00 $30.00 $24.70 $24.70 C UB HHA $30.00 $30.00 $24.70 $ UB UB UB 0-20 Independent Therapists $29.56 $29.56 $24.35 $ UB Independent Therapists $29.56 $29.56 $24.35 $24.35 C UB 0-20 HHA $29.56 $29.56 $24.35 $24.35 C UB HHA $29.56 $29.56 $24.35 $ UB UB UB UB C UB 0-20 HHA $28.69 $28.69 $23.63 $23.63 C UB HHA $28.69 $28.69 $23.63 $ UB UB

4 C UB 0-20 HHA $28.69 $28.69 $23.63 $23.63 C UB HHA $28.69 $28.69 $23.63 $ UB 0-20 CORF/ORF and Independent Therapists $32.94 $32.94 $27.13 $ UB CORF/ORF and Independent Therapists $32.94 $32.94 $27.13 $ UB 0-20 Independent Therapists $26.54 $26.54 $21.85 $ UB Independent Therapists $26.54 $26.54 $21.85 $21.85 C UB 0-20 HHA $26.54 $26.54 $21.85 $21.85 C UB HHA $26.54 $26.54 $21.85 $ UB 0-20 Independent Therapists $23.94 $23.94 $19.71 $ UB Independent Therapists $23.94 $23.94 $19.71 $19.71 C UB 0-20 HHA $23.94 $23.94 $19.71 $19.71 C UB HHA $23.94 $23.94 $19.71 $ UB 0-20 Independent Therapists $27.03 $27.03 $22.26 $ UB Independent Therapists $27.03 $27.03 $22.26 $22.26 C UB 0-20 HHA $27.03 $27.03 $22.26 $22.26 C UB HHA $27.03 $27.03 $22.26 $ UB 0-20 Independent Therapists $29.16 $29.16 $24.02 $ UB Independent Therapists $29.16 $29.16 $24.02 $24.02 C UB 0-20 HHA $29.16 $29.16 $24.02 $24.02 C UB HHA $29.16 $29.16 $24.02 $ UB UB C UB 0-20 HHA $28.69 $28.69 $23.63 $23.63 C UB HHA $28.69 $28.69 $23.63 $ UB UB C UB 0-20 HHA $28.69 $28.69 $23.63 $23.63 C UB HHA $28.69 $28.69 $23.63 $ UB UB C UB 0-20 HHA $28.69 $28.69 $23.63 $23.63 C UB HHA $28.69 $28.69 $23.63 $23.63

5 UB UB C UB 0-20 HHA $28.69 $28.69 $23.63 $23.63 C UB HHA $28.69 $28.69 $23.63 $ UB UB UB 0-20 Independent Therapists $29.42 $29.42 $24.23 $ UB UB 0-20 Independent Therapists $30.31 $30.31 $24.96 $ UB 0-20 Independent Therapists $30.43 $30.43 $25.06 $ UB Independent Therapists $30.43 $30.43 $25.06 $25.06 C UB 0-20 HHA $30.43 $30.43 $25.06 $25.06 C UB HHA $30.43 $30.43 $25.06 $25.06 *Type of Service (TOS: 1 = Medical Services, C = Home Health Services : UB = Services provided by a therapy assistant *Provider Type: CORF/ORF = Comprehensive Outpatient Rehabilitation Facility/Outpatient Rehabilitation Facility, HHA = Home Health