Reimbursement Rate Changes for Texas Medicaid Therapy Assistant Services to Become Effective Dec. 1, 2017

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1 Reimbursement Rate Changes for Texas Medicaid Therapy Assistant Services to Become Dec. 1, 2017 Information posted Nov. 15, 2017 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. for dates of service on or after Dec. 1, 2017, services rendered by a therapy assistant (billed with modifier UB) will be reimbursed 85 percent of the rate paid to a licensed therapist. The table at the end of this article contains updated reimbursement 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 rad.hhs.texas.gov/rate-packets. For more information, call the TMHP Contact Center at

2 UB UB UB UB UB UB UB UB Independent Therapists $ $ $91.61 $91.61 Independent Therapists $ $ $91.61 $91.61 Independent Therapists $45.53 $45.53 $38.70 $38.70 Independent Therapists $45.53 $45.53 $38.70 $38.70 Independent Therapists $ $ $ $ Independent Therapists $ $ $ $ Independent Therapists $16.51 $16.51 $14.03 $14.03 Independent Therapists $16.51 $16.51 $14.03 $14.03 C UB 0-20 HHA $16.51 $16.51 $14.03 $14.03 C UB HHA $16.51 $16.51 $14.03 $ UB 0-20 Independent Therapists $16.15 $16.15 $13.73 $ UB Independent Therapists $16.15 $16.15 $13.73 $13.73 C UB 0-20 HHA $16.15 $16.15 $13.73 $13.73 C UB HHA $16.15 $16.15 $13.73 $ UB 0-20 Independent Therapists $19.74 $19.74 $16.78 $ UB Independent Therapists $19.74 $19.74 $16.78 $16.78 C UB 0-20 HHA $19.74 $19.74 $16.78 $16.78 C UB HHA $19.74 $19.74 $16.78 $16.78

3 UB UB Independent Therapists $11.13 $11.13 $9.46 $9.46 Independent Therapists $11.13 $11.13 $9.46 $9.46 C UB 0-20 HHA $11.13 $11.13 $9.46 $9.46 C UB HHA $11.13 $11.13 $9.46 $ UB 0-20 Independent Therapists $24.05 $24.05 $20.44 $ UB Independent Therapists $24.05 $24.05 $20.44 $20.44 C UB 0-20 HHA $24.05 $24.05 $20.44 $20.44 C UB HHA $24.05 $24.05 $20.44 $ UB 0-20 Independent Therapists $6.82 $6.82 $5.80 $ UB Independent Therapists $6.82 $6.82 $5.80 $5.80 C UB 0-20 HHA $6.82 $6.82 $5.80 $5.80 C UB HHA $6.82 $6.82 $5.80 $ UB 0-20 Independent Therapists $6.10 $6.10 $5.19 $ UB Independent Therapists $6.10 $6.10 $5.19 $5.19 C UB 0-20 HHA $6.10 $6.10 $5.19 $5.19 C UB HHA $6.10 $6.10 $5.19 $ UB 0-20 Independent Therapists $7.54 $7.54 $6.41 $ UB Independent Therapists $7.54 $7.54 $6.41 $6.41 C UB 0-20 HHA $7.54 $7.54 $6.41 $6.41

4 C UB HHA $7.54 $7.54 $6.41 $ UB 0-20 Independent Therapists $37.07 $37.07 $31.51 $ UB Independent Therapists $37.07 $37.07 $31.51 $31.51 C UB 0-20 HHA $37.07 $37.07 $31.51 $31.51 C UB HHA $37.07 $37.07 $31.51 $ UB 0-20 Independent Therapists $35.29 $35.29 $30.00 $ UB Independent Therapists $35.29 $35.29 $30.00 $30.00 C UB 0-20 HHA $35.29 $35.29 $30.00 $30.00 C UB HHA $35.29 $35.29 $30.00 $ UB UB UB 0-20 Independent Therapists $34.78 $34.78 $29.56 $ UB Independent Therapists $34.78 $34.78 $29.56 $29.56 C UB 0-20 HHA $34.78 $34.78 $29.56 $29.56 C UB HHA $34.78 $34.78 $29.56 $ UB UB UB 0-20

5 UB C UB 0-20 HHA $33.75 $33.75 $28.69 $28.69 C UB HHA $33.75 $33.75 $28.69 $ UB UB C UB 0-20 HHA $33.75 $33.75 $28.69 $28.69 C UB HHA $33.75 $33.75 $28.69 $ UB 0-20 CORF/ORF and Independent Therapists $38.75 $38.75 $32.94 $ UB CORF/ORF and Independent Therapists $38.75 $38.75 $32.94 $ UB 0-20 Independent Therapists $31.22 $31.22 $26.54 $ UB Independent Therapists $31.22 $31.22 $26.54 $26.54 C UB 0-20 HHA $31.22 $31.22 $26.54 $26.54 C UB HHA $31.22 $31.22 $26.54 $ UB 0-20 Independent Therapists $28.16 $28.16 $23.94 $ UB Independent Therapists $28.16 $28.16 $23.94 $23.94 C UB 0-20 HHA $28.16 $28.16 $23.94 $23.94 C UB HHA $28.16 $28.16 $23.94 $ UB 0-20 Independent Therapists $31.80 $31.80 $27.03 $27.03

6 UB Independent Therapists $31.80 $31.80 $27.03 $27.03 C UB 0-20 HHA $31.80 $31.80 $27.03 $27.03 C UB HHA $31.80 $31.80 $27.03 $ UB 0-20 Independent Therapists $34.31 $34.31 $29.16 $ UB Independent Therapists $34.31 $34.31 $29.16 $29.16 C UB 0-20 HHA $34.31 $34.31 $29.16 $29.16 C UB HHA $34.31 $34.31 $29.16 $ UB UB C UB 0-20 HHA $33.75 $33.75 $28.69 $28.69 C UB HHA $33.75 $33.75 $28.69 $ UB UB C UB 0-20 HHA $33.75 $33.75 $28.69 $28.69 C UB HHA $33.75 $33.75 $28.69 $ UB UB C UB 0-20 HHA $33.75 $33.75 $28.69 $28.69 C UB HHA $33.75 $33.75 $28.69 $28.69

7 UB UB C UB 0-20 HHA $33.75 $33.75 $28.69 $28.69 C UB HHA $33.75 $33.75 $28.69 $ UB UB UB 0-20 Independent Therapists $34.61 $34.61 $29.42 $ UB UB 0-20 Independent Therapists $35.66 $35.66 $30.31 $ UB 0-20 Independent Therapists $35.80 $35.80 $30.43 $ UB Independent Therapists $35.80 $35.80 $30.43 $30.43 C UB 0-20 HHA $35.80 $35.80 $30.43 $30.43 C UB HHA $35.80 $35.80 $30.43 $30.43 *Type of Service (TOS: 1 = Medical Services, C = Home Health Services **Modifier: UB = Services provided by a therapy assistant ***Provider Type: CORF/ORF = Comprehensive Outpatient Rehabilitation Facility/Outpatient Rehabilitation Facility, HHA = Home Health ncy and Independent Therapist (includes Early Childhood Intervention (ECI) and physicians)