All Outpatient PT/OT claims must contain the valid NPI number of the OPR physician, physician assistant, nurse practitioner, or provider associated with an Individualized Family Service Plan (IFSP), in accordance with Program Rule 8.125.8.A. Pursuant to the Affordable Care Act's requirements that State Medicaid Agencies ensure correct ordering, prescribing, and referring (OPR) National Provider Identification (NPI) numbers be on the claim form (42 CFR § 455.440):. An approved Individualized Family Service Plan (IFSP) for Early Intervention PT/OT. All PT/OT services must have a written order, referral, or prescription by any of the following:. #FLORIDA MEDICARE TIMELY FILING GUIDELINES 2018 CODE#
Providers should refer to the Code of Colorado Regulations, Qualified Non-Physician Practitioners Eligible to Provide Physician's Services (-10, Section 8.200.2.C), for further regulatory information when providing physical and occupational therapy.
Physical and occupational therapists not employed by an agency, clinic, hospital, or physician may bill Health First Colorado directly, otherwise it is the employer who bills directly for the services. Providers will find enrollment information on the Provider Revalidation & Enrollment web page. Therapy may also be rendered by licensed and enrolled physicians, physician assistants, and advanced practice nurses as allowed by their respective scopes of practice.Īll providers must submit a completed provider enrollment to become a Health First Colorado provider. Medical records must still indicate the assistant performed the services. Therefore, the supervising therapist's NPI number must be used as the rendering provider number on the claim form for services rendered by the assistant.
OTAs cannot enroll with Health First Colorado and cannot place any identifying number on a claim form. Occupational therapy assistants (OTA) must practice under the general supervision of a Colorado registered occupational therapist. Occupational therapists must be registered by DORA pursuant to Title 12 Article 40.5. PTAs cannot enroll with Health First Colorado and cannot place any identifying number on a claim form. Physical therapist assistants (PTA) must be certified by DORA pursuant to Title 12 Article and must work under the supervision of a licensed physical therapist as defined in the Colorado Physical Therapy Practice Act (§ 12-41-203(2) C.R.S.) and accompanying rules as promulgated by the State Board of Physical Therapy. Supervision authority extends to the limits stated in the Physical Therapists Practice Act per section C.R.S. Physical therapists must be licensed by the Colorado Department of Regulatory Agencies (DORA) pursuant to Title 12 Article 41.106 and may supervise up to four individuals at one time who are not physical therapists, including certified nurse aides, to assist in the therapist's clinical practice. Licensed physical therapists (PTs) and registered occupational therapists (OTs) who meet the qualifications prescribed by federal regulations for participation at 42 CFR 484.4 and who meet all the requirements under state law are eligible to become Colorado Medical Assistance providers. Submit claims for payment to Health First Colorado. Providers must be enrolled as a Health First Colorado (Colorado's Medicaid Program) provider in order to: Determining What Time Counts Towards 15-Minute Timed Codes Counting Minutes for Timed Codes in 15 Minute Units Eligible Outpatient PT/OT Procedure Codes. 
National Correct Coding Initiative (NCCI).
Rehabilitative and Habilitative Therapy Definitions. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).
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