Beyond just fees, this tool seems like a bit of a magic wand re. listing relevant modifiers and directing users to relevant portions of the Medicaid manual.
Examples of usefulness:
Example 1 -- 45 min. psychotherapy by a LCSW:
- Go to link: http://public.tmhp.com/FeeSchedules/Default.aspx.
- Click on "fee search" in the left margin.
- Enter CPT code "90834" (Psychotherapy, 45 minutes with patient and/or family member)
- Enter program "Medicaid"
- Enter Date of Service: 9/14/15
- Enter Supplier "Medical supplier (durable medical equipment [DME]); licensed clinical social worker (LCSW)" (yes... LCSWs are alphabetized under Medical suppliers/DME -- perhaps because social workers in hospital settings often perform those functions of helping patients get a cane/wheelchair, etc. -- and other examples of DME, but of course LCSWs provide a much wider scope of services including psychotherapy, and the Texas Chapter of the National Association of Social Workers has asked for LCSWs not to be listed under DME.)
- Enter provider specialty: "Licensed clinical social worker"
- Click "Submit"
Tool will give you this info.:
- Go to link: http://public.tmhp.com/FeeSchedules/Default.aspx.
- Click on "fee search" in the left margin.
- Enter HCPCS Code "G9012" (Other specified case management service not elsewhere classified)
- Enter program "Medicaid"
- Enter Date of Service: 9/14/15
- Enter Supplier "Case Management/HCBS Provider"
- Enter provider specialty: "Maternity Service Clinic (MSC)/Children and Pregnant Women Case Management"
- Click "Submit"
- You get this -- which is very helpful re. modifiers:
Provider Manuals
Volume 2: Behavioral Health, Rehabilitation, and Case Management Services Handbook1/1/0001
The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Provider Handbooks August 2015 Behavioral ...
http://www.tmhp.com/TMPPM/TMPPM_Living_Manual_Current/Vol2_Behavioral_Health_Handbook.pdf - 1MB
Item Details
Example 3 -- Lastly, you will be told if you have input a code that is not billable. For example -- this is what you get if you try to see what the reimbursement is for an LCSW to provide a 45 min. medical (evaluation and management code or E&M code) "+90836". The tool will correctly tell you this is not billable --
In summary, the uses of this tool:
- look-up reimbursement rates for current services or for prospective new business
- become more familiar with certain codes, and be corrected when they are not billable
- identify acceptable modifiers
- be directed to exact parts of the provider manual
Thanks for reading! We hope you find the online fee lookup (ONF) tool useful: http://public.tmhp.com/FeeSchedules/Default.aspx.