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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsSeptember 2015

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Section 1905(a)(11) of the Social Security Act, includes physical therapy and related services in the definition of medical assistance
42 CFR §440.110 defines physical therapy, occupational therapy, and services for individuals with speech, hearing and language disorders
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
Physical and occupational therapists and speech/language pathologists who are individually enrolled with the Delaware Medical Assistance Program (DMAP) are reimbursed at a rate using Healthcare Common Procedure Coding System (HCPCS) procedure codes. Reimbursement rates shall be based on the Medicare Relative Value (RVU).
When billing for PT, OT, and Speech/language pathology services, providers shall use the appropriate Physical Medicine and Rehabilitation CPT Procedure codes and specify the diagnosis with accurate ICD-9-CM codes. When billing for physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders, providers shall use the appropriate Physical Medicine and Rehabilitation Current Procedural Terminology (CPT) codes and specify the diagnosis with accurate International Classification of Diseases, Clinical Modification (ICD-CM) codes.
1.1.5 Therapists who bill the DMAP for services provided to eligible Medicaid clients beneficiaries are required to verify that they actually rendered the service which is being billed. The following are the documentation requirements to verify the identity of the performing provider:
1.1.5.2 A performing therapist in a group practice is required to initial the entry in the client's Medicaid beneficiary’s medical record at the time of service. Any system that a particular office may have in place that identifies the performing provider for each service will be acceptable.
1.1.6 Therapists that provide Hippotherapy must be certified by the American Hippotherapy Certification Board as a Hippotherapy Professional Clinical Specialist (HCPS).
2.2.4.6 Hippotherapy – is a form of physical, occupational and speech-language therapy in which a therapist uses the multidimensional movements of a horse to provide carefully graded motor and sensory input. A foundation is established to improve neurological function and sensory processing, which can be generalized to a wide range of daily activities. Hippotherapy involves therapeutic exercise, neuromuscular education, kinetic activities, therapeutic activities, sensory integration activities and individual speech therapy. This treatment strategy utilizes the movement of the horse as part of an integrated rehabilitation plan of care to achieve functional outcomes.
Last Updated: December 31 1969 19:00:00.
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