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***** New Procedure – Global Authorizations: *****
As requested by many providers, MAPS-MD will be changing the authorization letters to reflect the banding of authorizations which is explained in the July 1, 1998 MAPS-MD Provider Manual, under the Service Matrix Section.
To summarize, services in the same letter category (A,B,C, or D) are currently interchangeable to meet consumer needs, and may be claimed based on what is provided. Authorization letters will be changed to reflect this "banding" on the authorization side as explained in the following examples:
Example 1: 90847 and 90806 are both category A services. The provider requested 90806 on the authorization plan and were given fifteen 90806 services for a two month period. One month into treatment, the provider realizes the consumer needs 90847 as well. The provider may exchange some, or all, of the remaining 90806’s for 90847’s. Essentially, the provider has fifteen category A services which may be used during that two-month period. The authorization letters will now have the number of category A services authorized instead of specific CPT codes. For provider convenience, we have now included 90801 in category A services. However, MAPS-MD would not expect to see more than one 90801 per treating practitioner, per episode of care.
Example 2: The provider requested, and received thirty-nine on site PRP services and fifteen off site PRP services for a period of three months. The consumer begins to decompensate and needs more off site services than authorized. The provider actually has a total of fifty-four rehabilitation services authorized during that three-month period and can exchange some on site services for off site services. The authorization letter will now state an authorization of fifty-four category D rehabilitation services for the three-month period.
Please be aware that you must continue to bill with the appropriate specific CPT code for the services provided.
Sample authorization letters are attached and you should expect to see these new letters within the next three to six weeks.
Psychological Testing Clarification:
An additional Authorization for psychological testing is not required for inpatient facilities, when completed by a staff psychologist and included as an Ancillary charge on an inpatient claim for HSCRC regulated facilities. The facility component is payable under the inpatient authorization, except for IMD’s as it is included in the per diem rate. These charges may be reviewed retrospectively. However, authorization is always required for all other instances of Psychological Testing, and this would include testing provided by a non-staff psychologist in an inpatient setting. The Authorization Guidelines for Psychological Testing can be found in the MAPS-MD Provider Manual Chapter 5, pages 5-20-2 and 5-20-3.
Residential Rehabilitation:
Effective 8/1/99, you may no longer bill W9508. If you are billing for intensive level staffing you must also bill for housing. Please bill with a W9550 when you have housing charges and intensive level staffing (i.e. W9550 = W9507 and W9508). When you only have housing charges bill a W9507.
Partial Hospitalization Clarification:
As currently outlined in the Provider Manual, a physician service may be billed in addition to the Partial Hospital stay, when provided in a hospital setting. Non-hospital based partial programs do not have a provision for this additional physician payment, as it is already included in the partial hospital rate.
Intensive Outpatient Services (IOP):
Physician services for an IOP program may receive reimbursement, in addition to the IOP rate, only when provided in a hospital based IOP program. Physician services provided in a non-hospital-based program are already included in the IOP rate.
Gray Zone "Ability to Pay" Schedule:
New Authorization Letter: