471 NAC 14-005. BILLING AND PAYMENT FOR OCCUPATIONAL THERAPY (OT) AND PHYSICAL THERAPY (PT) SERVICES

005. BILLING AND PAYMENT FOR OCCUPATIONAL THERAPY (OT) AND PHYSICAL THERAPY (PT) SERVICES. 005.01 GENERAL BILLING REQUIREMENTS. Providers must comply with all applicable billing requirements codified in these regulations . 005.02 BILLING INSTRUCTIONS. The provider must bill Nebraska Medicaid using the appropriate claim form or electronic format. 005.03 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. 005.04 MEDICAL NECESSITY DOCUMENTATION. The provider must provide the following information when submitting a claim for occupational therapy (OT) or physical therapy (PT) services: (A) The date of illness or injury onset; (B) The date the occupational therapy (OT) or physical therapy (PT) plan established; (C) The date occupational therapy (OT) or physical therapy (PT) services started; and (D) The number of occupational therapy (OT) or physical therapy (PT) visits from onset. 005.05 HOME HEALTH AGENCY. Services offered through a home health agency require prior authorization. 005.06 PAYMENT FOR INDIVIDUAL PROVIDERS. Claims are paid by Nebraska Medicaid 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.