Commercial ABA Program. Medicare Mental Health Reimbursement Rates by CPT Code: Medicare pays well! Please note that all ABA providers must have a unique NPI # for ABA services prior to completing the Medicaid application. Choose the option that works best for you. Duplication of Claims Reimbursement Policy. This reimbursement policy is intended to ensure that you are reimbursed Optum and its respective marks are trademarks of Optum, Inc. All other brands or product names are trademarks or registered marks of their respective owners. Florida Hawaii Privacy Policy | Terms of Use | Site Map | Accessibility Note: Adobe Acrobat Reader is required to view and print PDFs. 07-01-19).pdf, Health Homes Fee Schedule (Eff -07-01-19).pdf, Combination of SUD Services (Eff-07-1-17).pdf, PBHS Reimbursement Schedule A (Eff-07-01-18 Rev-03-14-19).pdf, PBHS Reimbursement Schedule B (Eff-07-01-18 Rev-03-14-19).pdf, 8-507/PWC Grant Program Fee Schedule (Eff. B Bundle Codes Reimbursement Policy . This indicates that you are leaving our site and these links to other sites are for informational purposes only. Optum monitors the website for updates and our module helps you stay current and save time as you: The Optum module – and all new releases – are available through fast and convenient web downloads. Explore claims options. They are important for organizations that adjudicate or review workers’ compensation and auto medical bills, those who want to set up their own fee schedules, and those who need to confirm reimbursement amounts to Medicare. ERAs, EFTs and electronic EOBs. Optum Maryland gives care to people served by the Maryland Department of Health (MDH), Behavioral Health Administration (BHA). Consultation Services Reimbursement Policy. Reimbursement for each co-surgeon is 62.5% of the global surgery rate under the Medicare Physician Fee Schedule (MPFS). Electroconvulsive Therapy Reimbursement Policy. We offer state fee schedules for the District of Columbia, all 45 states that mandate workers’ comp and the Federal workers’ comp fee schedule (OWCP). No. ABA Maximum Allowed Amounts Effective May 1, 2020 97153 (15 min) 97155 (15 min) 3 of 2 97151 (15 min) 97156 (15 min) T1023 (per measure reported) LOC State Location Name BCBA-D/BCBA/Assistant BCBA-Ds BCBAs BCaBAs BTs BCBA-Ds BCBAs BCaBAs BCBA-D/BCBA/Assistant BCBA-D/BCBA ABA Maximum Allowed Amounts Effective May 1, 2020 Tips for BCBAs and ABA Therapy providers applying for In Network status with Optum/UBH Insurance. We invite you to look through this site to see the many ways we can serve you. REIMBURSEMENT Learn more about the care we offer We also offer unique services, resources and programs to people with Medicare Advantage. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy. â¢Once the transition to the new 2019 CPT® codes is made Optum® will no longer utilize HCPCS codes for ABA services. 97157-HN $0 $6.25 ea./15 min. You can use these rate differences as estimates on the rate changes for private insurance companies, however itâs best to ensure the specific CPT code you want to use is covered by insurance. The following applied behavior analysis (ABA) reimbursement rates are for care received under the Autism Care Demonstration. Optum is focused on empowering accurate, effortless payments for all by providing solutions at every touchpoint in the billing and claim lifecycle. 0362T $18 $31.25 California providers only - Do I need to resubmit my previously paid claims? FEE SCHEDULE DATA. The Standard Option provides geographically-adjusted Medicare Physician Fee Schedule amounts for all RBRVS-valued procedures. 4.12.3 Submitting your claims electronically is quick, convenient and easy. Oregon