OHCA Policies and Rules

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317:30-5-675.Eligible providers
[Revised 9-01-00]
(a) Eligible speech and hearing providers must be either state licensed speech/language pathologists or state licensed audiologists who:
(1) hold a certificate of clinical competence from the American Speech and Hearing Association; or
(2) have completed the equivalent educational requirements and work experience necessary for the certificate; or
(3) have completed the academic program and are acquiring supervised work experience to qualify for the certificate.
(b) All eligible providers of speech and hearing services must have entered into a contract with the Oklahoma Health Care Authority to perform speech and hearing services.

317:30-5-676.Coverage by category
[Revised 01-14-13]
Payment is made for speech and hearing services as set forth in this Section.
(1) Children. Coverage for children is as follows:
(A) Preauthorization required. All therapy services, including the initial evaluation, must be prior authorized. Prior to the initial evaluation, the therapist must have on file a signed and dated prescription or referral for the therapy services from the member's physician or other licensed practitioner of the healing arts. The prescribing or referring provider must be able to provide, if requested, clinical documentation from the member's medical record that supports the medical necessity for the evaluation and referral.
(B) Speech/Language Services. Speech/language therapy services may include speech/language evaluations, individual and group therapy services provided by a state licensed speech/language pathologist.
(C) Hearing aids. Hearing and hearing aid evaluations include pure tone air, bone and speech audiometry by a state licensed audiologist. Payment is made for a hearing aid following a recommendation by a Medical or Osteopathic physician and a hearing aid evaluation by a state licensed audiologist.
(2) Adults. There is no coverage for adults for services rendered by individually contracted providers. Coverage for adults is permitted in an outpatient hospital setting as described in 30-5-42.1.
(3) Individuals eligible for Part B of Medicare. Services provided to Medicare eligible recipients are filed directly with the fiscal agent.
317:30-5-677.Payment rates
[Revised 9-01-00]
Payment is made in accordance with the current allowable Medicaid fee schedule.

317:30-5-678.Procedure codes
[Revised 9-01-00]
The appropriate procedure codes used for billing speech and hearing services are found in the Physicians' Current Procedural Terminology (CPT) Coding Manual.

317:30-5-679.Claim form [REVOKED]
[Revoked 6-27-02]

317:30-5-680.Team therapy (Co-treatment)
[Issued 08-13-10]
Therapists, or therapy assistants, working together as a team to treat one or more members cannot each bill separately for the same or different service provided at the same time to the same member.
(1) CPT codes are used for billing the services of one therapist or therapy assistant. The therapist cannot bill for his/her services and those of another therapist or a therapy assistant, when both provide the same or different services, at the same time, to the same member.
(2) If multiple therapies (physical therapy, occupational therapy, and/or speech therapy) are provided to one member at the same time, only one therapist can bill for the entire service, or each therapist can divide the service units.
(3) Providers must report the CPT code for the time actually spent in the delivery of the modality requiring constant attendance and therapy services. Pre- and post-delivery services are not to be counted in determining the treatment service time. The time counted must begin when the therapist is directly working with the member to deliver treatment services.
(4) The time counted is the time the member is being treated. If the member requires both a therapist and an assistant, or even two therapists, each service unit of time the member is being treated can count as only one unit of each code. The service units billed must equal the total time the member was receiving actual therapy services. It is not allowable for each therapist or therapy assistant to bill for the entire therapy session. The time the member spends not being treated, for any reason, must not be billed.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.