MEDICAL POLICY No R4

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "MEDICAL POLICY No. 91579-R4"

Transcription

1 *Note: This policy incorporates the previously separate policy Pervasive Developmental Disabilities # Summary of Changes Due to the Patient Protection and Affordable Care Act (PPACA), applied behavioral analysis for the treatment of autism spectrum disorder is now considered an essential health benefit and must be included in the definition of Habilitation Services as ordered by the State of Michigan effective January 1, 2014 for PPACA compliant health plans. Due to ongoing legislative changes, there will no longer be any annual visit limitations or annual dollar limitations applied to services for the treatment of Autism Spectrum Disorder. Please note the removal of the benefit limitations will take place as plans renew on or after January 1, See plan documents for applicable copayment and coinsurance that apply to various Treatments of Autism Spectrum Disorder categories. Due to differences in employer sponsored products, individual plan documents will govern in any situations in which this policy conflicts with the plan documents. Clarifications: Policy title changed from Autism Spectrum & Pervasive Developmental Disorders to Autism Spectrum Disorders. Deletions: Additions: Pg 1, Section I, A, eligibility criteria updated to read: This policy applies to individuals diagnosed with Autism Spectrum Disorder. Pg 2, Section I, Diagnosis and Evaluation, A, criteria updated to reflect an evaluation is required every three years for a child in ongoing treatment. Pg 2, Section I, Diagnosis and Evaluation, A, b, Autism Diagnostic Observation Schedule 2 (ADOS-2) added to list of Priority Health preferred diagnostic evaluation tools for autism. Pg 4, Section I, Exclusions, C, updated to reflect treatment coverage for all other developmental disorders including Social Communication Disorder, with the exception of medical management, are excluded from coverage. Pg 6, Section IV, Description, updated to reflect changes made in the newest revision of the DSM (DSM V). I. POLICY/CRITERIA Eligibility MEDICAL POLICY AUTISM SPECTRUM DISORDERS Effective Date: January 1, 2015 Review Dates: 12/10, 12/11, 8/12, 8/13, 12/13, 11/14 Date Of Origin: October 13, 2010 Status: Current A. This policy applies to individuals diagnosed with Autism Spectrum Disorder by a licensed physician or a licensed psychologist B. This policy applies to children and adolescents through age 18. Page 1 of 12

2 C. Applied Behavior Analysis (ABA) treatment services must be prior approved through Priority Health s Behavioral Health department. D. ABA and psychological treatment services for autism must be performed by a contracted provider who is supervised by a Board Certified Behavior Analyst (BCBA) or licensed psychologist so long as the services performed are commensurate with the psychologist s formal university training and supervised experience. Prior authorization is required for ABA and psychological treatment. E. For speech therapy treatment, physical therapy, and occupational therapy coverage is provided if performed by a contracted and licensed therapist who has met Priority Health s criteria for treatment of autism. Prior authorization for these therapies is not required. Diagnosis and Evaluation A. Initial evaluation for diagnostic clarification, including psychological and neuropsychological testing, is covered by the Plan when performed by a contracted licensed physician or psychologist. The Plan may request a diagnostic evaluation not more than once every three years. For a child in ongoing treatment, a new evaluation is required every three years. Use of diagnostic and screening tools with good reliability, sensitivity and specificity is required prior to approving treatment. Priority Health preferred diagnostic evaluation tools for autism: a. Autism Diagnostic Observation Scale (ADOS) b. Autism Diagnostic Observation Schedule-2 (ADOS-2) c. Autism Diagnostic Interview Revised (ADI-R) Validated screening tools include, but may not be limited to: d. Childhood Autism Rating Scale e. Australian Scale for Asperger s Syndrome f. Gilliam Autism Rating Scale-4 (GARS-4) g. Gilliam Asperger s Disorder Scale (GADS) h. Social Communication Questionnaire (SCQ) i. Social Responsiveness Scale (SRS) B. Referral to a contracted autism treatment program must be ordered by a licensed physician. Priority Health may request a second diagnostic opinion from either (a) an approved Centers of Excellence program or (b) a contracted, licensed PhD psychologist/neuropsychologist with specialized training in autism spectrum disorders prior to authorizing ABA autism treatment. Page 2 of 12

3 C. To determine the most appropriate level of treatment, the approved ABA Centers of Excellence program s evaluation and assessment should involve a multidisciplinary approach that includes: a. family interview and history b. developmental history c. use of a standardized parent completed checklist/behavior rating scale d. review of school records (if applicable) e. medical screening for co-morbid diagnoses f. structured behavioral observations D. Evaluation by the ABA Centers of Excellence program may result in a course of treatment that may vary in duration and length depending upon the individual treatment needs of the child. An Applied Behavior Analysis treatment plan must be supervised by a Board Certified Behavior Analyst (BCBA) who oversees the applied behavior analysis treatment and coordinates care with other medical professionals involved in the child s treatment as necessary. E. Referral to a contracted, licensed Speech Therapist for treatment of speech deficits as result of Autism must be ordered by a licensed physician. F. The Plan may request to the treatment program that an annual developmental evaluation be conducted to measure treatment progression. Treatment Coverage A. Coverage for treatment of Applied Behavior Analysis may include the following multidisciplinary components as dictated by the initial assessment and subsequent treatment plan: a. Physician b. Board Certified Behavior Analyst c. Psychologist (PhD) d. Psychologist (LLP) e. Social Worker (LMSW) f. Supervised Staff B. Approved outpatient ABA Centers of Excellence programs will be required to document progress in the treatment plan for consideration of continuing stay approval. Continuing stay criteria includes demonstrating measurable progress based on a treatment plan that specifically addresses clinical intervention in the following areas: a. Educational b. Psychosocial c. Behavioral d. Targeted symptom management Page 3 of 12

4 e. Skills training f. Parent training g. Care coordination with school and medical practitioners If the above clinical interventions do not result in measurable progress over a 6 month intervention period, then further treatment may be denied. Measurable progress includes demonstrated improvements in at least 2 of the following areas: Language Academic performance Adaptive behaviors Social behaviors C. Coverage for speech therapy treatment is covered when ordered by a licensed physician. See exclusion section of this policy for speech therapy treatments that are not approved for coverage of autism Exclusions A. Adults age 19 or older B. Services provided by family or household members C. Treatment coverage for all other developmental disorders including Social Communication Disorder with exception of medication management. Rationale: The Individuals with Disabilities Education Act (IDEA) of 1990 (20 U.S.C.A Sections 1400 et seq.) is federal legislation that assures all children with disabilities have available to them a free appropriate public education. A free appropriate public education encompasses special education and related services, including some therapy services that are provided at public expense. In Michigan, pursuant to this federal legislation, special education, intervention and related services are proved to children from birth to age 26, provided criteria are met to qualify for services. (see Section V of this policy for diagnostic code exclusions) D. Treatments that are not based in scientific evidence and unproven treatments are not covered by Priority Health. These treatments include, but are not limited to the following: a. Secretin therapy b. Dietary interventions c. Hormonal therapies d. Vitamin therapies e. Intravenous immunoglobulin therapy Page 4 of 12

5 f. Chelation therapy g. Facilitated communication h. Sensory Based Treatments i. Auditory Integration Therapy j. Relationship Development Intervention (RDI) k. Floor Time or Individual Difference Relationship (DIR) l. Non-biological complementary and alternative medicine treatments II. MEDICAL NECESSITY REVIEW A. EVALUATION & DIAGNOSTIC TESTING Required *Not Required Not Covered B. AUTISM TREATMENT SERVICES Applied Behavior Analysis (ABA), including ABA treatment in the home environment *Required Not Required Not Covered Mental Health Treatment for *Required Not Required Not Covered Speech Therapy Treatment for Required *Not Required Not Covered For Medicare, please see LCD (L30489) for coverage details For Individual products, please see plan documents. *NOTE: All services in A and B above for Priority Health Medicaid and Healthy Michigan Plan members are managed through Michigan s Department of Community Mental Health. Services in A and B above are not covered by the health plan for Priority Health Medicare members. Page 5 of 12

6 III. APPLICATION TO PRODUCTS Coverage is subject to member s specific benefits. Covered Autism Spectrum Disorder services are specified in your Schedule of Copayments and Deductibles under treatment for Autism Spectrum Disorder. HMO/EPO: This policy applies to insured HMO/EPO plans. POS: This policy applies to insured POS plans. PPO: This policy applies to insured PPO plans. Consult individual plan documents as state mandated benefits may apply. If there is a conflict between this policy and a plan document, the provisions of the plan document will govern. ASO: For self-funded plans, consult individual plan documents. If there is a conflict between this policy and a self-funded plan document, the provisions of the plan document will govern. INDIVIDUAL: For individual policies, consult the individual insurance policy. If there is a conflict between this medical policy and the individual insurance policy document, the provisions of the individual insurance policy will govern. MEDICARE: Coverage is determined by the Centers for Medicare and Medicaid Services (CMS); if a coverage determination has not been adopted by CMS, this policy applies. MEDICAID/HEALTHY MICHIGAN PLAN: For Medicaid/Healthy Michigan Plan members, this policy will apply. Coverage is based on medical necessity criteria being met and the appropriate code(s) from the coding section of this policy being included on the Michigan Medicaid Fee Schedule located at: If there is a discrepancy between this policy and the Michigan Medicaid Provider Manual located at: the Michigan Medicaid Provider Manual will govern. For Medical Supplies/DME/Prosthetics and Orthotics, please refer to the Michigan Medicaid Fee Schedule to verify coverage. MICHILD: For MICHILD members, this policy will apply unless MICHILD certificate of coverage limits or extends coverage. IV. DESCRIPTION (ASDs) are life-long neurological disabilities of unknown causes. The spectrum of autistic disorders includes previous DSM IV classifications of Autistic Disorder, Asperger Syndrome, Rett Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorders Not Otherwise Specified (also known as Atypical Autism). The newest revision of the DSM (DSM V) combines these disorders into the broader category of autism spectrum disorders. Rett Disorder, if associated with ASD, is now additionally specified as a known genetic condition. Individuals with these disorders exhibt 1) deficits in social communication and interaction and 2) restricted, repetitive patterns of behavior, interests or activities. ASD diagnosis requires evidence of symptoms within both domains. Symptoms must be present in the early developmental period but may not become fully manifest until social demands exceed limited capacities and/or may be masked by learned strategies later in life. ASD may be diagnosed with other comorbid conditions such as ADHD, anxiety and language impairment. Recent prevalence data estimates that about 1 in 88 children have been identified with an autism spectrum disorder (ASD). ASDs are generally not curable and chronic Page 6 of 12

7 management is required. Although outcomes are variable and specific behavioral characteristics change over time, most children with ASDs remain with symptoms of autism as adults. V. CODING INFORMATION Note: Services for Priority Medicaid and Healthy Michigan Plan Members are paid through Michigan s Department of Community Mental Health. ICD-9 Codes (for dates of service on or before September 30, 2015): The following services are covered under this policy when billed with the following dx: Autistic disorder, current or active state Other specified pervasive developmental disorders, current or active state (Asperger s disorder, Rhett s disorder) Unspecified pervasive developmental disorder, current or active state ICD-10 Codes that apply to this policy (for dates of service on or after October 1, 2015): The following services are covered under this policy when billed with the following dx: F84.0 Autistic disorder F84.5 Asperger's syndrome F84.8 Other pervasive developmental disorders F84.9 Pervasive developmental disorder, unspecified BEHAVIORAL HEALTH SERVICES Prior authorization required Mental Health Treatment Revenue Codes (facility only) 0914 Individual therapy Mental Health Treatment CPT/HCPCS Codes Prior authorization required when billed with primary autism spectrum disorder diagnoses Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; ABA TREATMENT SERVICES in center, office, or home prior authorization required Page 7 of 12

8 Revenue Codes (facility only) 0914 Individual therapy CPT/HCPCS Codes H0031 Mental health assessment, by nonphysician H0032 Mental health service plan development by nonphysician H2019 Therapeutic behavioral services, per 15 minutes SPEECH THERAPY - no prior authorization required Revenue Codes (facility only) Speech Therapy-Language Pathology CPT/HCPCS Codes Evaluation of speech fluency (eg, stuttering, cluttering) Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) Behavioral and qualitative analysis of voice and resonance S9152 Speech therapy, re-evaluation Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals PHYSICAL & OCUUPATIONAL THERAPY - no prior authorization required Revenue Codes (facility only) Physical Therapy Occupational Therapy CPT/HCPCS Codes Physical therapy evaluation Physical therapy re-evaluation Occupational therapy evaluation Occupational therapy re-evaluation Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes Page 8 of 12

9 97532 Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes BEHAVIORAL HEALTH EVALUATION - prior authorization is required for Medicaid/Healthy Michigan Plan members for these services regardless of diagnosis. These services are NOT dependent on diagnoses above and are not subject to the autism benefit: Psychiatric diagnostic interview examination Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication BEHAVIORAL HEALTH TESTING - no prior authorization required Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI and WAIS), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI), administered by a computer, with qualified health care professional interpretation and report Developmental screening, with interpretation and report, per standardized instrument form (Not payable to facility providers) Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified Page 9 of 12

10 health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report ICD-9 Non Covered Codes including but not limited to: (for dates of service on or before September 30, 2015): Autistic disorder, residual state Childhood disintegrative disorder, current or active state Childhood disintegrative disorder, residual state Other specified pervasive developmental disorder, residual state Unspecified pervasive developmental disorder, residual state See also: Policy Rehabilitative Medicine Services Policy Speech Therapy Policy Neuropsychological and Psychological Testing CPT/HCPCS Codes Services not covered with the diagnoses above include but are not limited to: Behavioral Therapy Speech Therapy Occupational Therapy Physical Therapy Services not covered regardless of diagnosis: 0359T Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report 0360T Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 30 minutes of technician time, face-toface with the patient 0361T Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; each additional 30 minutes of technician time, face-to-face with the patient (List separately in addition to code for primary service) 0362T Exposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more technicians; first 30 minutes of technician(s) time, face-to-face with the patient 0363T Exposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the Page 10 of 12

11 0364T 0365T 0366T 0367T 0368T 0369T 0370T 0371T 0372T 0373T 0374T assistance of one or more technicians; each additional 30 minutes of technician(s) time, face-to-face with the patient (List separately in addition to code for Adaptive behavior treatment by protocol, administered by technician, face-toface with one patient; first 30 minutes of technician time Adaptive behavior treatment by protocol, administered by technician, face-toface with one patient; each additional 30 minutes of technician time (List separately in addition to code for primary procedure) Group adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; first 30 minutes of technician time Group adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; each additional 30 minutes of technician time (List separately in addition to code for primary procedure Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; each additional 30 minutes of patient face-to-face time (List separately in addition to code for primary procedure) Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) Adaptive behavior treatment social skills group, administered by physician or other qualified health care professional face-to-face with multiple patients Exposure adaptive behavior treatment with protocol modification requiring two or more technicians for severe maladaptive behavior(s); first 60 minutes of technicians' time, face-to-face with patient Exposure adaptive behavior treatment with protocol modification requiring two or more technicians for severe maladaptive behavior(s); each additional 30 minutes of technicians' time face-to-face with patient (List separately in addition to code for primary procedure) VI. REFERENCES Ben-Itzchak E, Zachor DA. The effects of intellectual functioning and autism severity on outcome of early beavhavioral intervention for children with autism. Res Dev Disabil. 2007;28(3): Centers for Disease Control and Prevention. Community Report from the Autism and Developmental Disabilities Monitoring (ADDM) Network. Report.pdf. Eikeseth S, Smith T, Jahr E, Eldevik S. Intensive behavioral treatment at school for 4-7-year-old children with autism. A 1-year comparison controlled study. Behav Modif. 2002;26(1): Page 11 of 12

12 Eikeseth S, Smith T, Jahr E, Eldevik S. Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7: a comparison controlled study. Behav Modif. 2007;31(3): Howard JS, Sparkman CR, Cohen HG, et al. A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Res Dev Disabil. 2005;26(4): Itzchak, B. E, Lahat E, Burgin R, Zachor AD. Cognitive, behavior and intervention outcome in young children with autism. Res Dev Disabil. 2008; 29(5): Myers, S. M. Management of children with autism spectrum disorders. American Academy of Pediatrics. 2007; 120(5): Reichow B, Wolery M. Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model. J Autism Dev Disord. 2009; 39(1): Spreckley M, Boyd R. Efficacy of applied behavioral intervention in preschool children with autism for improving cognitive, language, and adaptive behavior: A systematic review and meta-analysis. 2008; PMID: AMA CPT Copyright Statement: All Current Procedure Terminology (CPT) codes, descriptions, and other data are copyrighted by the American Medical Association. This document is for informational purposes only. It is not an authorization, certification, explanation of benefits, or contract. Receipt of benefits is subject to satisfaction of all terms and conditions of coverage. Eligibility and benefit coverage are determined in accordance with the terms of the member s plan in effect as of the date services are rendered. Priority Health s medical policies are developed with the assistance of medical professionals and are based upon a review of published and unpublished information including, but not limited to, current medical literature, guidelines published by public health and health research agencies, and community medical practices in the treatment and diagnosis of disease. Because medical practice, information, and technology are constantly changing, Priority Health reserves the right to review and update its medical policies at its discretion. Priority Health s medical policies are intended to serve as a resource to the plan. They are not intended to limit the plan s ability to interpret plan language as deemed appropriate. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment they choose to provide. The name Priority Health and the term plan mean Priority Health, Priority Health Managed Benefits, Inc., Priority Health Insurance Company and Priority Health Government Programs, Inc. Page 12 of 12

MEDICAL POLICY No. 91615-R0 AUTISM SPECTRUM DISORDERS

MEDICAL POLICY No. 91615-R0 AUTISM SPECTRUM DISORDERS AUTISM SPECTRUM DISORDERS Effective Date: January 1, 2016 Review Dates: 11/15 Date Of Origin: November 11, 2015 Status: New Due to the Patient Protection and Affordable Care Act (PPACA), applied behavioral

More information

Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder

Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder Policy Number: Original Effective Date: MM.12.022 01/01/2016 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration

More information

Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder

Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder Policy Number: Original Effective Date: MM.12.022 01/01/2016 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration

More information

MEDICAL POLICY SUBJECT: APPLIED BEHAVIOR ANALYSIS FOR THE TREATMENT OF AUTISM SPECTRUM DISORDERS

MEDICAL POLICY SUBJECT: APPLIED BEHAVIOR ANALYSIS FOR THE TREATMENT OF AUTISM SPECTRUM DISORDERS MEDICAL POLICY SUBJECT: APPLIED BEHAVIOR ANALYSIS FOR PAGE: 1 OF: 7 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product covers

More information

Applied Behavior Analysis for Autism Spectrum Disorders

Applied Behavior Analysis for Autism Spectrum Disorders Applied Behavior Analysis for Autism Spectrum Disorders I. Policy University Health Alliance (UHA) will reimburse for Applied Behavioral Analysis (ABA), as required in relevant State of Hawaii mandates,

More information

Psychological and Neuropsychological Testing

Psychological and Neuropsychological Testing Psychological and Neuropsychological Testing I. Policy University Health Alliance (UHA) will reimburse for Psychological and Neuropsychological Testing (PT/NPT) when it is determined to be medically necessary

More information

Medical Policy Original Effective Date: 07-22-09 Revised Date: 01-27-16 Page 1 of 5

Medical Policy Original Effective Date: 07-22-09 Revised Date: 01-27-16 Page 1 of 5 Disclaimer Medical Policy Page 1 of 5 Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans or the plan may have broader or

More information

PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING

PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING Status Active Medical and Behavioral Health Policy Section: Behavioral Health Policy Number: X-45 Effective Date: 01/22/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members

More information

sad EFFECTIVE DATE: 10 01 2013 POLICY LAST UPDATED: 06 02 2015

sad EFFECTIVE DATE: 10 01 2013 POLICY LAST UPDATED: 06 02 2015 Medical Coverage Policy Autism Spectrum Disorders Mandate sad EFFECTIVE DATE: 10 01 2013 POLICY LAST UPDATED: 06 02 2015 OVERVIEW Applied behavioral analysis (ABA) is the process of systematically applying

More information

Preschool/School Supportive Health Services Program (SSHSP)

Preschool/School Supportive Health Services Program (SSHSP) SSHSP providers must use this select list of Current Procedural Terminology () codes to bill Medicaid for SSHSP services. This handout contains codes for the following SSHSP services that can be billed

More information

Provider Type 14 Billing Guide

Provider Type 14 Billing Guide State policy The Medicaid Services Manual (MSM) is on the Division of Health Care Financing and Policy (DHCFP) website at http://dhcfp.nv.gov (select Manuals from the Resources webpage). MSM Chapter 400

More information

TESTING GUIDELINES PerformCare: HealthChoices. Guidelines for Psychological Testing

TESTING GUIDELINES PerformCare: HealthChoices. Guidelines for Psychological Testing TESTING GUIDELINES PerformCare: HealthChoices Guidelines for Psychological Testing Testing of personality characteristics, symptom levels, intellectual level or functional capacity is sometimes medically

More information

Clinical Policy Title: Applied behavior analysis (ABA)

Clinical Policy Title: Applied behavior analysis (ABA) Clinical Policy Title: Applied behavior analysis (ABA) Clinical Policy Number: 11.04.03 Effective Date: October 1, 2015 Initial Review Date: May 15, 2015 Most Recent Review Date: June 17, 2015 Next Review

More information

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT Summary of Changes MEDICAL POLICY MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD ADOLESCENT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 14, 2014 Status: Current Clarifications:

More information

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated

More information

MISSOURI. 2. When did the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect?

MISSOURI. 2. When did the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect? MISSOURI FREQUENTLY ASKED QUESTIONS ABOUT THE AUTISM INSURANCE REFORM LAW 1. Generally speaking, what does the Missouri law do? The law requires all group health plans to cover the diagnosis and treatment

More information

Preschool/School Supportive Health Services Program (SSHSP)

Preschool/School Supportive Health Services Program (SSHSP) Evaluation 90801 2000 PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION Psychotherapy includes continuing psychiatric evaluation, codes 90801 and 90802 are not separately reportable with individual psychotherapy

More information

Florida Senate - 2016 SB 144

Florida Senate - 2016 SB 144 By Senator Ring 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 A bill to be entitled An act relating to autism; creating s. 381.988, F.S.; requiring a physician, to whom

More information

FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law. What does the Florida Autism Legislation (Senate Bill Number 2654) do?

FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law. What does the Florida Autism Legislation (Senate Bill Number 2654) do? FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law What does the Florida Autism Legislation (Senate Bill Number 2654) do? There are three major components of the Florida Autism Legislation,

More information

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES PROCEDURE CODES & FEE SCHEDULE

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES PROCEDURE CODES & FEE SCHEDULE NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES PROCEDURE CODES & FEE SCHEDULE Table of Contents General Rules and Information... 3 Occupational Therapist, Physical Therapist and Speech Language

More information

Autistic Disorder Asperger s Disorder Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)

Autistic Disorder Asperger s Disorder Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) Medical Policy Manual Topic: Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder Date of Origin: January 2012 Section: Behavioral Health Last Reviewed Date: January 2015 Policy No:

More information

Disorders Mandate. Medical Coverage Policy Autism Spectrum EFFECTIVE DATE: 10/01/2013 POLICY LAST UPDATED: 08/05/2014

Disorders Mandate. Medical Coverage Policy Autism Spectrum EFFECTIVE DATE: 10/01/2013 POLICY LAST UPDATED: 08/05/2014 Medical Coverage Policy Autism Spectrum Disorders Mandate EFFECTIVE DATE: 10/01/2013 POLICY LAST UPDATED: 08/05/2014 OVERVIEW Applied behavioral analysis (ABA) is the process of systematically applying

More information

INDIANA: Frequently Asked Questions About the Autism Insurance Reform Law. What does Indiana s Autism Spectrum Disorder Insurance Mandate do?

INDIANA: Frequently Asked Questions About the Autism Insurance Reform Law. What does Indiana s Autism Spectrum Disorder Insurance Mandate do? INDIANA: Frequently Asked Questions About the Autism Insurance Reform Law What does Indiana s Autism Spectrum Disorder Insurance Mandate do? Broadly speaking, the insurance mandate requires insurance providers

More information

DD Procedural Codes for Administrative Examinations **To be used solely by DD staff**

DD Procedural Codes for Administrative Examinations **To be used solely by DD staff** DD Procedural Codes for Administrative Examinations **To be used solely by DD staff** Overview An Administrative Examination is an evaluation required by the Department of Human Services (DHS) to help

More information

State of New Jersey DEPARTMENT OF BANKING AND INSURANCE PO BOX 325 TRENTON, NJ 08625-0325 JON S. CORZINE

State of New Jersey DEPARTMENT OF BANKING AND INSURANCE PO BOX 325 TRENTON, NJ 08625-0325 JON S. CORZINE State of New Jersey DEPARTMENT OF BANKING AND INSURANCE PO BOX 325 TRENTON, NJ 08625-0325 JON S. CORZINE NEIL N. JASEY Governor TEL (609) 292-7272 Commissioner BULLETIN NO: 10-02 TO: ALL HOSPITAL, MEDICAL

More information

Subject: Health; health insurance; autism spectrum disorders. Statement of purpose: This bill proposes to require health insurers6

Subject: Health; health insurance; autism spectrum disorders. Statement of purpose: This bill proposes to require health insurers6 2010 Page 1 1 2 3 4 5 S.262 Introduced by Senators Carris and Campbell Referred to Committee on Finance Date: Janaury 5, 2010 Subject: Health; health insurance; autism spectrum disorders Statement of purpose:

More information

HB 159 mandates that private insurance provides the following for individuals diagnosed with Autism spectrum Disorders:

HB 159 mandates that private insurance provides the following for individuals diagnosed with Autism spectrum Disorders: HB 159 mandates that private insurance provides the following for individuals diagnosed with Autism spectrum Disorders: "Applied behavior analysis" means the design, implementation, and evaluation of environmental

More information

JOHNS HOPKINS HEALTHCARE

JOHNS HOPKINS HEALTHCARE Page 1 of 9 ACTION: New : Effective Date: 03/01/2013 Revising : Review Dates: 12/4/2015 Superseding : Archiving : Retiring : Johns Hopkins HealthCare (JHHC) provides a full spectrum of health care products

More information

Insurance Coverage for Autism Spectrum Disorder; HB 2744

Insurance Coverage for Autism Spectrum Disorder; HB 2744 Insurance Coverage for Autism Spectrum Disorder; HB 2744 HB 2744 requires health insurance coverage for the diagnosis and treatment of Autism Spectrum Disorder (ASD) in children under the age of 12 years

More information

Applied Behavior Analysis (ABA)

Applied Behavior Analysis (ABA) MEDICAL POLICY POLICY RELATED POLICIES POLICY GUIDELINES DESCRIPTION SCOPE BENEFIT APPLICATION RATIONALE REFERENCES CODING APPENDIX HISTORY Applied Behavior Analysis (ABA) Number 3.01.510 Effective Date

More information

The Do s & Don'ts of Mental Health Coding

The Do s & Don'ts of Mental Health Coding The Do s & Don'ts of Mental Health Coding Presented for Anthem Blue Cross and Blue Shield By Penny Osmon, BA, CPC October 31, 2007 Wisconsin Medical Society, Copyright 2007 CPT codes, descriptions and

More information

AUTISM SPECTRUM DISORDER TREATMENTS

AUTISM SPECTRUM DISORDER TREATMENTS AUTISM SPECTRUM DISORDER TREATMENTS Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage

More information

JOHNS HOPKINS HEALTHCARE

JOHNS HOPKINS HEALTHCARE Page 1 of 9 ACTION: New : Effective Date: 03/01/2013 Revising : Review Dates: 12/4/2015 Superseding : Archiving : Retiring : Johns Hopkins HealthCare (JHHC) provides a full spectrum of health care products

More information

AUTISM SPECTRUM DISORDER RELATED SERVICES FOR EPSDT ELIGIBLE INDIVIDUALS

AUTISM SPECTRUM DISORDER RELATED SERVICES FOR EPSDT ELIGIBLE INDIVIDUALS AUTISM SPECTRUM DISORDER RELATED SERVICES FOR EPSDT ELIGIBLE INDIVIDUALS I. GENERAL POLICY Autism Spectrum Disorder (ASD) Related Services are not covered benefits for Traditional Medicaid beneficiaries.

More information

PENNSYLVANIA'S AUTISM INSURANCE ACT: A FACT SHEET. Prepared by the Disability Rights Network of Pennsylvania

PENNSYLVANIA'S AUTISM INSURANCE ACT: A FACT SHEET. Prepared by the Disability Rights Network of Pennsylvania PENNSYLVANIA'S AUTISM INSURANCE ACT: A FACT SHEET Prepared by the Disability Rights Network of Pennsylvania Prior to the Pennsylvania Autism Insurance Act (sometimes called "Act 62"), 40 P.S. 764h, almost

More information

Therapy Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2016 Hewlett Packard Enterprise Development LP

Therapy Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2016 Hewlett Packard Enterprise Development LP INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Therapy Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 9 P U B L I S H E D : F E B R U A R Y 2 5, 2 0 1 6 P O L I

More information

IRG/APS Healthcare Utilization Management Guidelines for West Virginia Psychological Services Version 3.1

IRG/APS Healthcare Utilization Management Guidelines for West Virginia Psychological Services Version 3.1 IRG/APS Healthcare Utilization Management Guidelines for West Virginia Psychological Services CHANGE LOG Replace Changes Date of Change IRG/APS Healthcare Utilization Management Guidelines For West Virginia

More information

Board Certified Behavior Analyst and Approved Autism Evaluation Centers. Blue Cross Blue Shield of Michigan Blue Care Network Provider Outreach

Board Certified Behavior Analyst and Approved Autism Evaluation Centers. Blue Cross Blue Shield of Michigan Blue Care Network Provider Outreach Board Certified Behavior Analyst and Approved Autism Evaluation Centers Blue Cross Blue Shield of Michigan Blue Care Network Provider Outreach September 2015 Enrollment Process 2 Enrollment Available networks:

More information

ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law

ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law What does Public Act 95 do? Broadly speaking, the Act does two main things: 1. It requires many private insurers to begin covering

More information

Chapter 7 Section 3.19. Applied Behavior Analysis (ABA) For Non- Active Duty Family Members (NADFMs) Who Participate In The ABA Pilot

Chapter 7 Section 3.19. Applied Behavior Analysis (ABA) For Non- Active Duty Family Members (NADFMs) Who Participate In The ABA Pilot Medicine Chapter 7 Section 3.19 Applied Behavior Analysis (ABA) For Non- Active Duty Family Members Issue Date: August 10, 2012 Authority: 10 USC 1079(a), Section 705 NDAA FY 2013 Public Law No: 112-239,

More information

Overview of DSM-5: Autism Spectrum Disorder

Overview of DSM-5: Autism Spectrum Disorder Overview of DSM-5: Autism Spectrum Disorder Courtney Burnette, PhD Clinical Psychologist UNM Center for Development and Disability Department of Pediatrics September 20, 2013 Objectives Recognize the changes

More information

ROLE OF SCHOOL PSYCHOLOGIST AS A RELATED SERVICE PROVIDER

ROLE OF SCHOOL PSYCHOLOGIST AS A RELATED SERVICE PROVIDER ROLE OF SCHOOL PSYCHOLOGIST AS A RELATED SERVICE PROVIDER I. Related Services Definition - IDEA According to the Individuals with Disabilities Education Act, psychological services include: Administering

More information

ADDITIONAL FUNDING SOURCES

ADDITIONAL FUNDING SOURCES Julie Guy, MT-BC & Angela Neve, MT-BC PO BOX 710772, San Diego, CA 92171-0772 info@themusictherapycenter.com 1.877.620.7688 fax & VM ADDITIONAL FUNDING SOURCES Our mission is to make music therapy accessible

More information

MEDICAL POLICY No. 91503-R4 BLOOD PRESSURE MONITORS & AMBULATORY BLOOD PRESSURE MONITORING

MEDICAL POLICY No. 91503-R4 BLOOD PRESSURE MONITORS & AMBULATORY BLOOD PRESSURE MONITORING BLOOD PRESSURE MONITORS & Effective Date: December 21, 2015 Review Dates: 01/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 11/14, 11/15 Date Of Origin: January 19, 2005 Status: Current

More information

MEDICAL POLICY No. 91332-R3 NON-ACUTE INPATIENT SERVICES

MEDICAL POLICY No. 91332-R3 NON-ACUTE INPATIENT SERVICES NON-ACUTE INPATIENT SERVICES Effective Date: November 16, 2007 Review Dates: 1/93, 12/99, 12/01, 12/02, 11/03, 11/04, 10/05, 10/06, 10/07, 10/08, 10/09, 10/10, 10/11, 10/12, 10/13, 11/14 Date of Origin:

More information

House File 1 - Introduced

House File 1 - Introduced House File 1 - Introduced HOUSE FILE BY ZIRKELBACH Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act requiring certain group health insurance policies,

More information

Applied Behavior Analysis (ABA) Provider Network Eligibility & Enrollment

Applied Behavior Analysis (ABA) Provider Network Eligibility & Enrollment An Independent Licensee of the Blue Cross Blue Shield Association. APPENDIX H AUTISM GUIDELINES Acknowledgement: Current Procedural Terminology (CPT ) is copyright 2015 American Medical Association. All

More information

Table of Contents. 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1

Table of Contents. 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 2 2.2 Special

More information

Autism Insurance Act Frequently Asked Questions and Answers

Autism Insurance Act Frequently Asked Questions and Answers Autism Insurance Act Frequently Asked Questions and Answers Overview What does Autism Insurance Act (Act 62) do? Broadly speaking, Act 62 does three main things: 1. It requires many private insurers to

More information

15 HB 429/AP A BILL TO BE ENTITLED AN ACT

15 HB 429/AP A BILL TO BE ENTITLED AN ACT House Bill 429 (AS PASSED HOUSE AND SENATE) By: Representatives Stephens of the 164 th, Wilkinson of the 52 nd, Shaw of the 176 th, Dollar of the 45 th, Rogers of the 29 th, and others A BILL TO BE ENTITLED

More information

WVPEIA/WVCHIP Applied Behavior Analysis (ABA) Billing and Payment Policy

WVPEIA/WVCHIP Applied Behavior Analysis (ABA) Billing and Payment Policy WVPEIA/WVCHIP Applied Behavior Analysis (ABA) The practice of Applied Behavior Analysis is defined as the application of the principals, methods, and procedures of the experimental analysis of behavior

More information

LOUISIANA: Frequently Asked Questions About the Autism Insurance Reform Law

LOUISIANA: Frequently Asked Questions About the Autism Insurance Reform Law LOUISIANA: Frequently Asked Questions About the Autism Insurance Reform Law What does the Autism Insurance Act (Act 648) do? Act 648 does several things: 1. Act 648 requires many health insurance plans

More information

WVPEIA/AccessWV/WVCHIP Applied Behavior Analysis (ABA)

WVPEIA/AccessWV/WVCHIP Applied Behavior Analysis (ABA) WVPEIA/AccessWV/WVCHIP Applied Behavior Analysis (ABA) Billing and Payment Policy The practice of Applied Behavior Analysis is defined as the application of the principals, methods, and procedures of the

More information

MEDICAL POLICY No. 91104-R7 DETOXIFICATION I. POLICY/CRITERIA

MEDICAL POLICY No. 91104-R7 DETOXIFICATION I. POLICY/CRITERIA DETOXIFICATION MEDICAL POLICY Effective Date: January 7, 2013 Review Dates: 1/93, 2/97, 4/99, 2/01, 12/01, 2/02, 2/03, 1/04, 1/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 11/14 Date

More information

Chapter 7 Section 3.18

Chapter 7 Section 3.18 Medicine Chapter 7 Section 3.18 Issue Date: August 10, 2012 Authority: 10 USC 1079(a), Section 705 NDAA FY 2013 Public Law No: 112-239, 32 CFR 199.4(c), and 32 CFR 199.6 1.0 CPT 1 PROCEDURE CODES 1181F,

More information

Occupational Therapy

Occupational Therapy Occupational Therapy Policy Number: Original Effective Date: MM.09.003 07/15/2003 Line(s) of Business: Current Effective Date: HMO; PPO; EUTF; HSTA; QUEST; Federal Plan 87 02/01/2012 Line(s) of Business

More information

Aetna Autism Spectrum Disorders (ASD) Support Program

Aetna Autism Spectrum Disorders (ASD) Support Program Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Autism Spectrum Disorders (ASD) Support Program Aetna Resources For LivingSM 44.02.919.1-ADO (9/12) 2 Autism

More information

MassHealth Eligibility Letter 209 May 1, 2013. Home- and Community-Based Services Waiver-Money Follows the Person

MassHealth Eligibility Letter 209 May 1, 2013. Home- and Community-Based Services Waiver-Money Follows the Person Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Eligibility Letter 209 May 1, 2013 TO: FROM: RE: MassHealth Staff Julian

More information

Billing Through Insurance Companies for ImPACT

Billing Through Insurance Companies for ImPACT Billing Through Insurance Companies for ImPACT Kenneth Podell, Ph.D., FACPN Dir., Div. of Neuropsychology & Sports Concussion Safety Program Henry Ford Health System, Detroit, MI Overview Terminology and

More information

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES Version 2015-1 Page 1 of 11 Table of Contents SECTION I REQUIREMENTS FOR PARTICIPATION IN MEDICAID 3 QUALIFIED PRACTITIONERS. 3

More information

Billing, Coding and Reimbursement Guide

Billing, Coding and Reimbursement Guide Billing, Coding and Reimbursement Guide Revised April 2014 Disclaimer: The information in this document has been compiled for your convenience and is not intended to provide specific coding or legal advice.

More information

Clarification of Medicaid Coverage of Services to Children with Autism

Clarification of Medicaid Coverage of Services to Children with Autism DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 CMCS Informational Bulletin DATE: July 7, 2014

More information

Coding and Billing Guidelines *Psychiatry and Psychology Services PSYCH-014 - L30489. Contractor Name Wisconsin Physicians Service (WPS)

Coding and Billing Guidelines *Psychiatry and Psychology Services PSYCH-014 - L30489. Contractor Name Wisconsin Physicians Service (WPS) Coding and Billing Guidelines *Psychiatry and Psychology Services PSYCH-014 - L30489 Contractor Name Wisconsin Physicians Service (WPS) Contractor Number 00951, 00952, 00953, 00954 05101, 05201, 05301,

More information

Guidelines for Documentation of a A. Learning Disability

Guidelines for Documentation of a A. Learning Disability Guidelines for Documentation of a Learning Disability A. Learning Disability B. Attention Deficit Disorder C. Psychiatric Disabilities D. Chronic Health Disabilities A. Learning Disability Students who

More information

Physical Therapy MM.09.005 07/15/2003

Physical Therapy MM.09.005 07/15/2003 Physical Therapy Policy Number: Original Effective Date: MM.09.005 07/15/2003 Line(s) of Business: Current Effective Date: HMO; PPO; EUTF; HSTA; QUEST; Federal Plan 87 09/28/2012 Line(s) of Business Excluded:

More information

Funding Options for Services

Funding Options for Services PO Box 10806 Austin, TX 78766 www.spectrumsocial.net (512) 524-5482 Funding Options for Services This resource is provided to families as a guide for pursuing possible funding options and should not be

More information

The Department of Vermont Health Access Medical Policy

The Department of Vermont Health Access Medical Policy State of Vermont Department of Vermont Health Access 312 Hurricane Lane, Suite 201 [Phone] 802-879-5903 Williston, VT 05495-2807 [Fax] 802-879-5963 www.dvha.vermont.gov Agency of Human Services The Department

More information

Autism Spectrum Disorder

Autism Spectrum Disorder Autism Spectrum Disorder Benefit information Premera Blue Cross (Premera) administers the Autism Spectrum Disorder (ASD) benefit for all eligible members. This unique benefit provides coverage for behavioral

More information

MA IN REHABILITATION IN LANGUAGE AND SPEECH PATHOLOGY (TAUGHT IN BULGARIAN)

MA IN REHABILITATION IN LANGUAGE AND SPEECH PATHOLOGY (TAUGHT IN BULGARIAN) MA IN REHABILITATION IN LANGUAGE AND SPEECH PATHOLOGY (TAUGHT IN BULGARIAN) Brief presentation of the program: The program is aimed at training specialists in treatment of children, adolescents and adults

More information

ValueOptions Autism Care Management Product. Bryan Davey, PhD, BCBA-D Christopher Dennis, MD, MBA, ValueOptions Chief Medical Officer

ValueOptions Autism Care Management Product. Bryan Davey, PhD, BCBA-D Christopher Dennis, MD, MBA, ValueOptions Chief Medical Officer ValueOptions Autism Care Management Product Bryan Davey, PhD, BCBA-D Christopher Dennis, MD, MBA, ValueOptions Chief Medical Officer Autism Spectrum Disorders Background 2 Autism Spectrum Disorders within

More information

Michigan Medicaid Autism Behavioral Health Treatment and Applied Behavior Analysis. CODING for Autism Behavioral Health Treatment and ABA Services

Michigan Medicaid Autism Behavioral Health Treatment and Applied Behavior Analysis. CODING for Autism Behavioral Health Treatment and ABA Services CODING for Autism Behavioral Health Treatment and ABA Services Applied Behavior Analysis (ABA) services are limited to children up to 21 years of age (i.e. eligibility to 21 st birthday) who are assessed

More information

Autism Spectrum Disorders: An Awareness Level Training for Educators

Autism Spectrum Disorders: An Awareness Level Training for Educators Autism Spectrum s: An Awareness Level Training for Educators Autism is the Fastest-Growing Developmental Disability More common than pediatric cancer, diabetes and AIDS combined Autism increased 172% during

More information

Your Anthem Blue Cross HMO Plan Amendment

Your Anthem Blue Cross HMO Plan Amendment Your Anthem Blue Cross HMO Plan Amendment Anthem Blue Cross ( Anthem ) agrees to modify your Combined Evidence of Coverage and Disclosure (Evidence of Coverage) Form by this amendment. All other provisions

More information

MEDICAL POLICY No. 91336-R9 SPEECH THERAPY I. POLICY/CRITERIA

MEDICAL POLICY No. 91336-R9 SPEECH THERAPY I. POLICY/CRITERIA SPEECH THERAPY MEDICAL POLICY No. Effective Date: November 25, 2014 Review Dates: 1/93,12/99, 8/01, 12/01, 5/02, 5/03, 5/04, 5/05, 4/06, 4/07, 7/07, 2/08, 2/09, 2/10, 2/11, 2/12, 8/12, 8/13, 12/13, 11/14,

More information

MATRIX -School Based Child Health MSI Codes and Descriptions

MATRIX -School Based Child Health MSI Codes and Descriptions MATRIX -School Based Child Health s and Descriptions AUDIOLOGY 22 27 Hearing screening 23 28 Hearing service, miscellaneous under the direction of the Audiologist under the direction of the Audiologist,

More information

Pediatric Case Study OCCUPATIONAL THERAPY EVALUATION REPORT AND INTERVENTION PLAN. Setting: community out-patient in-patient home based

Pediatric Case Study OCCUPATIONAL THERAPY EVALUATION REPORT AND INTERVENTION PLAN. Setting: community out-patient in-patient home based I. BACKGROUND INFORMATION Pediatric Case Study OCCUPATIONAL THERAPY EVALUATION REPORT AND INTERVENTION PLAN Date of report: Date of onset: Date of birth: Client s name: Date of referral: Age on date of

More information

School Based Health Services Medicaid Policy Manual MODULE 6 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES

School Based Health Services Medicaid Policy Manual MODULE 6 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES School Based Health Services Medicaid Policy Manual MODULE 6 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES BACKGROUND Administrative Requirements SCHOOL BASED HEALTH SERVICES ARE REGULATED BY THE CENTERS

More information

Behavioral Health Psychological/Neuropsychological Testing Guidelines

Behavioral Health Psychological/Neuropsychological Testing Guidelines Behavioral Health Psychological/Neuropsychological Testing Guidelines Psychological testing (procedural code 96101) and Neuropsychological Testing (procedural code 96118) involve the culturally and linguistically

More information

APPLIED BEHAVIOR ANALYSIS MEDICAL NECESSITY GUIDE

APPLIED BEHAVIOR ANALYSIS MEDICAL NECESSITY GUIDE APPLIED BEHAVIOR ANALYSIS MEDICAL NECESSITY GUIDE te: If there is a discrepancy between this guideline and a member's plan of benefits, the benefits plan will govern. In addition, coverage (and coverage

More information

Coverage and Recreation Therapy Services

Coverage and Recreation Therapy Services Coverage and Recreation Therapy Services Mary Lou Schilling, Ph.D., CTRS Associate Professor, Central Michigan University Past President, Central Rehabilitation Services, Inc. Session goals: Upon completion

More information

Billing, Coding and Reimbursement Guide

Billing, Coding and Reimbursement Guide Billing, Coding and Reimbursement Guide Updated January 2007 Disclaimer: The information in this document has been compiled for your convenience and is not intended to provide specific coding or legal

More information

Regence. Section: Mental Health Last Reviewed Date: January 2013. Policy No: 18 Effective Date: March 1, 2013

Regence. Section: Mental Health Last Reviewed Date: January 2013. Policy No: 18 Effective Date: March 1, 2013 Regence Medical Policy Manual Topic: Applied Behavior Analysis for the Treatment of Autism Spectrum Disorders Date of Origin: January 2012 Section: Mental Health Last Reviewed Date: January 2013 Policy

More information

Alabama Autism Task Force Preliminary Recommendations

Alabama Autism Task Force Preliminary Recommendations Alabama Autism Task Force Preliminary Recommendations Having reviewed the findings to date from the Alabama Autism Collaborative Group (AACG), The Alabama Autism Task Force proposes the following changes

More information

Potential Autism Spectrum Disorder Benefit

Potential Autism Spectrum Disorder Benefit Potential Autism Spectrum Disorder Board of Trustees March 27, 2014 Presentation Summary Recap of BOT interest Update on Autism Spectrum Disorder (ASD) Design Development Comparison of Proposed and HB

More information

Clinical Policy Guideline

Clinical Policy Guideline Clinical Policy Guideline Policy Title: Obesity Medical/Surgical Management Effective Date: 07/13/2004 Date Reviewed: 06/18/2011, 12/15/2011, 02/22/2012, 06/26/2012, 07/16/2012, 01/23/2013, 11/26/2014,

More information

TRICARE Comprehensive Autism Care Demonstration Q&A

TRICARE Comprehensive Autism Care Demonstration Q&A TRICARE Comprehensive Autism Care Demonstration Q&A Q1. When does the Autism Care Demo begin? A: The Department will begin implementing the new Autism Care Demonstration on July 25, 2014, with the goal

More information

Reimbursement Guide. Business Office: 598 Airport Boulevard Suite 1400 Morrisville NC 27560

Reimbursement Guide. Business Office: 598 Airport Boulevard Suite 1400 Morrisville NC 27560 Reimbursement Guide Business Office: 598 Airport Boulevard Suite 1400 Morrisville NC 27560 Contact: support@cognitrax.com Phone: 888.750.6941 Fax: 888.650.6795 www.cognitrax.com Diseases of the brain commonly

More information

Michigan Medicaid Applied Behavior Analysis and Autism Services Provider FAQ

Michigan Medicaid Applied Behavior Analysis and Autism Services Provider FAQ To view the policy related to Michigan Medicaid Autism ABA services, please refer to MSA bulletin 15-59. This policy can be found at: http://www.michigan.gov/documents/autism/msa_bulletin_15-59_507763_7.pdf

More information

Documentation Guidelines for ADD/ADHD

Documentation Guidelines for ADD/ADHD Documentation Guidelines for ADD/ADHD Hope College Academic Success Center This document was developed following the best practice recommendations for disability documentation as outlined by the Association

More information

ASSESSMENT OF AUTISM SPECTRUM DISORDERS. Kimberly Hunter, Ph.D. Clinical Psychologist Assistant Professor of Psychiatry at University of Toledo

ASSESSMENT OF AUTISM SPECTRUM DISORDERS. Kimberly Hunter, Ph.D. Clinical Psychologist Assistant Professor of Psychiatry at University of Toledo ASSESSMENT OF AUTISM SPECTRUM DISORDERS Kimberly Hunter, Ph.D. Clinical Psychologist Assistant Professor of Psychiatry at University of Toledo Overview Autism Spectrum Disorders Evidenced Based Assessment

More information

Occupational Therapy

Occupational Therapy Occupational Therapy I. Policy University Health Alliance (UHA) will reimburse for occupational therapy when it is determined to be medically necessary and when it meets the medical criteria guidelines

More information

Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required]

Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required] Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required] Medical Policy: MP-ME-05-09 Original Effective Date: February 18, 2009 Reviewed: April 22, 2011 Revised: This policy applies to products

More information

SCHOOL HEALTH SERVICES PROGRAM PROGRAM MANUAL

SCHOOL HEALTH SERVICES PROGRAM PROGRAM MANUAL SCHOOL HEALTH SERVICES PROGRAM PROGRAM MANUAL Section 2 Covered Services The School Health Services Program is a joint effort between the Colorado Department of Education and Department of Health Care

More information

NOTE: Implementation of this policy is contingent upon State Plan and Waiver approval from the Centers for Medicare & Medicaid Services (CMS).

NOTE: Implementation of this policy is contingent upon State Plan and Waiver approval from the Centers for Medicare & Medicaid Services (CMS). Bulletin Michigan Department of Community Health Bulletin Number: MSA 13-09 Distribution: Practitioners, Local Health Departments, Federally Qualified Health Centers, Rural Health Clinics, Medicaid Health

More information

Human Resources Department 211 South Williams Street Royal Oak, MI 48067

Human Resources Department 211 South Williams Street Royal Oak, MI 48067 Human Resources Department 211 South Williams Street Royal Oak, MI 48067 128-0316-2015 Approval of Autism Benefits Rider to the City s Self-insured Health Care Plan for Active Employees March 16, 2015

More information

Referred to Committee on Commerce and Labor. SUMMARY Revises provisions relating to autism spectrum disorders. (BDR 54-67)

Referred to Committee on Commerce and Labor. SUMMARY Revises provisions relating to autism spectrum disorders. (BDR 54-67) A.B. ASSEMBLY BILL NO. COMMITTEE ON COMMERCE AND LABOR (ON BEHALF OF THE LEGISLATIVE COMMITTEE ON HEALTH CARE) PREFILED DECEMBER, 0 Referred to Committee on Commerce and Labor SUMMARY Revises provisions

More information

Applied Behavioral Analysis Therapy (ABA)

Applied Behavioral Analysis Therapy (ABA) Applied Behavioral Analysis Therapy (ABA) For all Group Health plans with a benefit (except Microsoft) ABA requires preauthorization for initial and continued therapy. Specific coverage may be defined

More information

Behavioral Health and Developmental Disabilities Administration Waiver Conference 11/18/14

Behavioral Health and Developmental Disabilities Administration Waiver Conference 11/18/14 Behavioral Health and Developmental Disabilities Administration Waiver Conference 11/18/14 1 Introductions Lisa Grost, Autism Section Manager, MDCH Morgan VanDenBerg, Autism Behavioral Specialist, MDCH

More information

MEDICAID SERVICES MANUAL TRANSMITTAL LETTER CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY

MEDICAID SERVICES MANUAL TRANSMITTAL LETTER CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL TRANSMITTAL LETTER October 19, 2015 TO: FROM: SUBJECT: CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL CHANGES CHAPTER

More information