13.7.2 Billing Guidelines

HHSC negotiates contracts with providers which are reimbursed in accordance with 1 TAC §355.9040.

Post-acute rehabilitation non-residential services for traumatic brain injury and traumatic spinal cord injury can be either facility based or community based. Providers will bill a standard facility or community base fee for each hour the consumer is present plus a bill for each service that was provided.

For example, a participant receives services in a non-residential setting on Monday from 9 a.m. to 2 p.m. The participant receives one hour of physical therapy, one hour of occupational therapy, one hour of speech therapy, and one hour of art therapy. The provider bills for four hours of therapy, submitting a bill for each therapy code(s) and one hour of base for each hour at the facility for a total of five hours of base. The provider also submits supporting documentation for services provided.

If the participant does not receive therapy services from an approved certified or licensed professional while at the facility, the provider bills only for the time that the participant is at the facility and bills only at the base rate. For example, the participant attends the program for four hours, but does not receive any therapy services. The provider submits a bill for four hours at the base rate.

Bills for services must be submitted monthly. Data supporting the service must accompany each invoice. See Chapter 6 General Billing Guidelines for additional billing guidelines and must be uploaded in the CRS Data Reporting System.

Note: All services must be pre-authorized by the CRS counselor before services can be provided to a consumer.