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Important - Implementation of New PT & OT Evaluation HCPC Billing Codes Begins January 1st

Wednesday, December 7, 2016   (0 Comments)
Posted by: Kelly Griffiths
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As of 1/1/2017, existing physical therapy and occupational therapy evaluation and re-evaluation codes (97001, 97002, 97003, and 97004) will be end-dated and no longer billable to Wisconsin Medicaid.  The codes will be replaced by new codes (97161, 97162, 97163, 97164, 97165, 97166, 97167, and 97168). 


If a current valid PA has a procedure code for re-evaluation that will be used on a date of service on or after January 1, 2017, the provider will need to submit a PA amendment form requesting a change of the old re-evaluation code to the new code.  It is the provider’s responsibility to submit this request to change codes. Prior authorizations which span 2016-2017 in which the evaluation/re-evaluations were performed before January 1, 2017, do not need to be amended.  The 2016 codes should be billed on claims in these cases. 


Providers should continue to use appropriate modifiers on PA requests and claims submissions.  For Birth to 3 services, ForwardHealth will convert previously approved physical and occupational therapy PAs with procedure codes 97001-97006 on or after January 1, 2017, to add procedure codes 97161-97168.  Providers will receive a decision notice when the PAs have been converted.  No action is needed on the provider’s part.

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