Caregiver coding for Georgia Medicaid billing

The new codes: 97550, 97551, 97552 are caregiver codes that are new in 2024 and recently were added starting on 4/1/2024 quarterly manual on GAMMIS. These are codes you can use to help parents/guardians as caregivers for your patients. 

There are guidelines on your national board websites as to what the definition is for each code, but here's a generic description as all therapies can use it (taken from ASHA's site):

97550	Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; initial 30 minutes
97551	Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; each additional 15 minutes (list separately in addition to code for primary service) (Use 97551 in conjunction with 97550)
97552	Group caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers

I had a few questions as to the limits of these codes based on Medicaid's guidelines for Georgia. I reached out to the director of CIS and here's her response: 

I assume these units are combined with the 8 units allowed per month already? Yes, these procedures are included in the 8 units per month.

Does authorization need to be obtained if exceeded combined codes are used in conjunction with other cpts during a month? Yes

Are these codes considered part of "family of coding" pertaining to authorizations? No

Can another therapist see caregivers for training while therapy is being performed by another therapist with the patient at the same scheduled time? Currently, I have not seen any guidance that prohibits this scenario.

https://www.asha.org/practice/reimbursement/coding/new_codes_slp/

https://www.medbridge.com/blog/2024/01/new-caregiver-training-cpt-codes-for-pt-ot-slp-a-care-and-reimbursement-opportunity/#:~:text=97550%20%E2%80%93%20Caregiver%20training%20in%20strategies,safety%20practices)%20(without%20the%20patient

Here are the current rates for each code: 

97550 = $44.05

97551 = $21.86

97552 = $18.55

So each code is 1 unit. I have tested Medicaid only on these codes and you can bill the code on the same day as other therapies. For example: 

OT:

97530 4 units

97550 1 unit

As most of you know, usually you can't bill more than 5 units per day, but this coding does work. 

If anyone has any other info, please pass that info along to us as well. 

Medicaid Recredentialing, Peachstate payments, and lots more

Medicaid/Caresource/AG/BCW reminding you to recredential - I've received a ton of emails about this recently because everyone got contacted lately about it. Here's the deal: When you login to GAMMIS for a particular provider, it warns you 6 months in advance that the credentialing is do, and when it's do. For those providers who just ignore that warning during the pandemic, they're telling those providers that as of 9/15 they're throwing you out if you don't recredential asap. Here is the options on how to check:

How to check if recredentialing is needed

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Kaiser is calling providers to participate in network - there's been several providers asking me about this. Last time I worked with a clinic that was in network with Kaiser the rates were comparable to Medicaid, but their auth requirements were detailed, took awhile for each one.

Students working in therapy sessions - If you haven't heard, students can assist in sessions as of 4/1/2023. This is taken from the CIS policy manual:

Note: OTA, PTA, SLPA (aides or assistants) etc. are not allowed to provide services under the CIS Program. An exclusion to the above reference – students in an approved academic program and pursuing the requirements of their academic program are allowed to participate in CIS therapy sessions under the guidance of the licensed (supervising) practitioner. The licensed (supervising) practitioner must reference and follow the guidelines of their respective governing therapy practice act / association.

Peachstate is going to start sending ECHO credit card payments instead of checks in September - if you're familiar with other insurances doing this, such as Caresource, they are using the same company ECHO. If you're not familiar, they send a credit card image on your eobs so that you have to get a credit card processing system to get paid (such as square) and pay the fees. I haven't had good experiences with ECHO, hard to get them to set up EFT. I suggest setting up eft with payspan: https://www.payspanhealth.com/nps

pshp letter about credit cards

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Caresource changed their login website - You have to re-register with Caresource to login to their portal. They're requiring a two step verification now.

CMOS and the LOI forms - I sent an email earlier this year about these. I've seen letter of intents from Amerigroup, Kaiser, Humana, UHC, Peachstate, and Caresource so far. Again, it's up to you if you fill these out, but what you're saying by filling it out and signing the form that you support that insurance company to become a CMO (or stay a CMO) provider for Georgia since they're renewing contracts now. IT DOES NOT affect your contract with that insurance company. I've seen the emails they're sending, they're using words every way possible to make you think such. I find it disgusting that they're wording it in such a way and being so pushy about it as well. I have responded to some stating we are not interested in supporting your application for CMO due to horrible rates, authorization issues, lack of communication from reps, whatever you feel the need to complain about.

Eligibility for Medicaid and CMO patients - YOU MUST CHECK ELIGIBILITY ON GAMMIS TO MAKE SURE YOUR PATIENTS ARE ACTIVE. I do this already for providers I bill for, however please make sure you're doing it at least twice a month for your practice. Many members were terminated this month because of the ongoing eligibility redeterminations Medicaid/ Peach Care for Kids is going through right now. If a patent has lost coverage, direct them to register at gateway.ga.gov and see what information the state needs to continue coverage.

Amerigroup updated their provider rep list - finally! See attached... pshp's can be found here: https://www.pshpgeorgia.com/providers/resources/territory-list.html and Caresource can be found here: https://www.caresource.com/ga/providers/contact-us/medicaid/ (click on contracting managers link)

Letters of intent for CMOs

I've received a lot of questions asking about the numerous letters of intent or calls being received by CMOs or companies such as UHC/Optum, Aetna, or Molina asking to sign documents that look like they are taking on new providers or asking you to contract. These LOI's are basically requesting you as a provider/clinic to sign the documents to collect signatures with their bid to stay or become a CMO in July 2024 since it's open enrollment for Georgia to accept new CMOS.

If you wish to take the time and agree that the insurance company should receive your support, follow the instructions and fill out the documents they require. Do note, if they are elected to become a CMO, you will have to still credential with that particular CMO again (unless you already hold a contract with that current CMO company). The LOI's you receive are not a contract. They do not help you become a participating provider. And remember you are not being reimbursed for your time to fill out these documents.

CareSource is also sending out notifications to update provider information. I believe of course this follows along with preparing for this application to stay a CMO in Georgia. It does help as a provider to update credentialing information with these companies, helps with billing processes, so make sure you do follow up with any notices received from their verify.betterdoctor.com site.