Medicaid Reimbursement No Longer Available for Physician Review of IEP and Corresponding Evaluations
THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234
Medicaid Unit
Robert J. Scalise,
Coordinator
Room 304 EB
Washington Avenue, Albany NY 12234
Phone: (518) 474-3227
Fax: (518) 486-3606
89
rscalise@mail.nysed.gov
Date: August
19, 2005
To: District Superintendents
Superintendents of Public
School Districts
Special Education Directors
Business Officials
Superintendents of 4201 Schools
County Executives
County Administrators
Central New York Regional Information Center
Regional Information
Centers
Medicaid Contacts
From: Robert J. Scalise, Coordinator - Medicaid Services Unit
Subject: Medicaid Reimbursement No Longer Available for Physician Review of IEP and Corresponding Evaluations
The New York State Education Department has been advised by the New York State Department of Health (DOH) of a change to the School Supportive Health Services Program (SSHSP) and the Preschool Supportive Health Services Program (PSHSP).
DOH will no longer allow Medicaid reimbursement to school districts and counties for a physician’s record review of a student’s IEP and the corresponding evaluations resulting in a recommendation for all eligible services on the IEP. This record review and recommendation for all services was billable under the Medical Evaluation rate, codes 5301 for SSHSP and 5310 for PSHSP. This change in reimbursement, effective September 1, 2005, does not impact school districts’ and counties’ billings for medical evaluations, an actual physical conducted by a physician, physician assistant or nurse practitioner that is used in IEP Review deliberations. A medical evaluation is defined as the recording of chief complaints; present illness; family history; past medical history; personal history; social history; a system review; a complete physical evaluation; the ordering of appropriate diagnostic tests and procedures; and a recommended plan of treatment.
If you have any questions regarding this change please contact me at the address above or Michael Albino from the New York State Department of Health at his email address: mca03@health.state.ny.us or his telephone: 518 473-9303.