Providers are required to use CPT and HCPCS procedure codes when submitting claims for SBS. Providers will need to include the appropriate modifier(s) for each procedure code as indicated in the following table. If more than one modifier is listed, providers will be required to include all modifiers listed when submitting a claim, or the claim detail line may be denied.
Procedure Code |
Procedure Code Description |
Required Modifier(s) |
|---|---|---|
Speech and Language Pathology, Audiology, and Hearing Services |
||
92506 |
Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status |
TM, GN |
92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); individual |
TM, GN |
92508 |
group, two or more individuals |
TM, GN |
Occupational Therapy Services |
||
97003 |
Occupational therapy evaluation |
TM, GO |
97110 |
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility |
TM, GO |
97150 |
Therapeutic procedure(s), group (2 or more individuals) |
TM, GO |
Physical Therapy Services |
||
97001 |
Physical therapy evaluation (per 15 min) |
TM, GP |
97110 |
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility |
TM, GP |
97150 |
Therapeutic procedure(s), group (2 or more individuals) |
TM, GP |
Psychological Services |
||
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U1 |
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U2 |
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U3 |
Counseling Services |
||
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U4 |
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U5 |
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U6 |
Social Work Services |
||
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U7 |
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U8 |
T1024 |
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Short description: team evaluation & management) |
U9 |
Nursing Services |
||
T1001 |
Nursing assessment/evaluation |
TM |
T1002 |
RN services, up to 15 minutes |
TM |
T1003 |
LPN/LVN services, up to 15 minutes |
TM |
Special Transportation Services |
||
T2003 |
Non-emergency transportation; encounter/trip |
TM |
A0425 |
Ground mileage, per statue mile |
TM |
Attendant Care Services |
S5125 |
Attendant Care Services, per 15 minutes |
TM |