Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 14 - OCCUPATIONAL AND PHYSICAL THERAPY SERVICES
Section 471-14-005 - BILLING AND PAYMENT FOR OCCUPATIONAL THERAPY OR PHYSICAL THERAPY SERVICES
Universal Citation: 471 NE Admin Rules and Regs ch 14 ยง 005
Current through March 20, 2024
005.01 BILLING.
005.01(A)
GENERAL BILLING REQUIREMENTS. Providers must comply
with all applicable billing requirements codified in 471 NAC 3. In the event
that individual billing requirements in 471 NAC 3 conflict with billing
requirements outlined in this 471 NAC 14, the individual billing requirements
in 471 NAC 14 will govern.
005.01(B)
SPECIFIC BILLING
REQUIREMENTS.
005.01(B)(i)
BILLING INSTRUCTIONS. The provider must bill the
Department using the appropriate claim form or electronic format.
005.01(B)(ii)
USUAL AND CUSTOMARY
CHARGE. The provider or the provider's authorized agent must
submit the provider's usual and customary charge for each procedure code listed
on the claim. Healthcare Common Procedure Coding System (HCPCS) procedure codes
used by Medicaid are listed in the Nebraska Medicaid Practitioner Fee Schedule.
005.01(B)(iii)
MEDICAL
NECESSITY DOCUMENTATION. The provider must provide the following
information when submitting a claim for occupational therapy (OT) or physical
therapy (PT) services:
(1) Date of illness or
injury onset;
(2) Date occupational
therapy or physical therapy plan established;
(3) Date occupational therapy or physical
therapy started; and
(4) Number of
occupational therapy or physical therapy visits from onset.
005.02 PAYMENT.
005.02(A)
GENERAL PAYMENT REQUIREMENTS. The Department will
reimburse the Provider for services rendered in accordance with the applicable
payment regulations codified in 471 NAC 3. In the event that individual payment
regulations in 471 NAC 3 conflict with payment regulations outlined in this 471
NAC 14, the individual payment regulations in 471 NAC 14 will govern.
005.02(B)
SPECIFIC PAYMENT
REQUIREMENTS.
005.02(B)(i)
PAYMENT FOR INDIVIDUAL PROVIDERS. The Department pays
for covered occupational therapy (OT) or physical therapy (PT) services at the
lower of:
(1) The provider's submitted charge;
or
(2) The allowable amount for
that Healthcare Common Procedure Coding System (HCPCS) or Current Procedural
Terminology (CPT) procedure code in the Nebraska Medicaid Practitioner Fee
Schedule in effect on the date that the service was rendered.
Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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