Physical Therapy

Physical Therapy School-Based Medicaid Expansion Information

Physical Therapy Guide from the UMASS and MassHealth

  • Description: Use this PowerPoint as your guide for the requirements to complete billing under the Expansion program. Please read the entire presentation and pay extra attention to the following slides:
    • To determine if services provided meet the definition of Medicaid Medical Necessity: Slides 13, 16-20, 31-38, 40-42
    • What is included in Comprehensive Evaluations: Slide 40
    • What is included in Treatment Plans: Slide 41
    • What is included in Service Authorization: Slide 43-46
    • What should be included in the Activity/Procedure Note on Service Documentation: Slide 50
    • ICD-10 Diagnosis Codes: Slide 65-66

Service Authorization and Service Authorization Guide

  • Description: A requirement for “backup” to substantiate Medicaid Medical Necessity includes comprehensive evaluation, treatment plan, and service authorization. Here you will find a copy of the Service Authorization for Physical Therapy. You will also find a guide that includes all the elements of Service Authorization. ***It is advised that you combine all the elements found on the Service Authorization Guide with your treatment plan for one document. Please note all required “backup” should be kept for 7 years in the case of an audit.


Service Documentation Paper Billing Form

  • In-District Service Documentation Billing Form
    • Description: The In-District Service Documentation form is used to document Medicaid Medically Necessity services that occurred and to submit for paper billing to NEMB. Please note many clinicians will be documenting in another platform such as Frontline, Aspen, PowerSchool, SNAP, or SimpleNote. Yet, the form can be used as a guide to identify the procedure codes for your specialty. ***If your district uses the paper Service Documentation forms to submit billing to NEMB please use this form. Once completed send them to your District’s internal Medicaid contact for the forms to be uploaded via the Sharefile to NEMB, minimally on a monthly basis.
  • Out-of-District Day & Residential Service Documentation Billing Forms
    • Description: The Out-Of-District Service Day and Residential Documentation form can be used to document Medicaid Medically Necessity services that occurred and to submit for paper billing to NEMB. Please provide these to the Out-of-District schools that your district’s Medicaid eligible students attend. They should be collected from the school at the end of each month and uploaded to the NEMB secure Sharefile, by your district’s internal Medicaid contact.


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