The Department limits therapy services for dates of service on or after January 1, 2019 to:
• $2,040 per calendar year for a combination of speech therapy services and physical therapy services.
• $2,040 per calendar year for occupational therapy services.
Services over the limitation can be billed with a KX modifier. The KX modifier is the provider’s attestation that the services continue to be medically necessary and require the skills of a licensed therapist.
Providers should only submit records requested by the Department. Documentation sent unsolicited, or not for a service requiring prior authorization, will not be reviewed by the Department. Un-reviewed documentation does not constitute approval or authorization of a service.
Information about how many therapy services a participant has used will be available in eligibility information at the DXC Technology, or by contacting DXC Technology Health PAS portal at (866) 686-4272. If you have questions about a denied claim contact a DXC Technology Customer Service Representative to read the memo on the denial.
Providers will be notified by the Department with a request for documentation when a retrospective review is being conducted. Requested documentation must be provided to the Department for inspection within ten business days from the date on the letter. Failure to provide the supporting documentation within this time frame may result in claim recoupment and further services for the participant being denied.
The required supporting documentation is outlined in the Idaho Medicaid Provider Handbook.
The next Therapy provider meeting will be held Friday, December 20, 2019, at 10:30 am MTN. The meeting agenda will appear in the December MedicAide newsletter. Minutes from previous meetings are available on the right hand toolbar and published in the MedicAide newsletter.
If you would like to be added to the contact list for these meetings, or you have an issue you would like to appear on the next meeting’s agenda, e-mail your request to MCPT@dhw.idaho.gov.