Family Peer Support

DRAFT

  • Fees also available in Portable Document Format (PDF)
Rate Code Description Unit Type Productivity
Adjustment
1st 6 mos of Waiver Downstate Fee
Productivity
Adjustment
Months 7–12 of Waiver Downstate Fee
Year 2+
Downstate Fee
Productivity
Adjustment
7/1/18–12/31/18 Upstate Fee
Productivity
Adjustment
1/1/19–6/30/19 Upstate Fee
Year 2+
Upstate Fee
Family Peer Support Bachelors Level (individual) (On–site) per 15 minutes $ 19.96 $ 17.71 $ 15.99 $ 17.80 $ 15.79 $ 14.26
Family Peer Support All other allowable service personnel (individual) (On–site) per 15 minutes $ 17.47 $ 15.49 $ 13.99 $ 15.57 $ 13.81 $ 12.48
Family Peer Support Bachelors Level– Individual – Off–site – Use this code if total off–site session is 45 minutes or less (3 or less units). If session is one hour or more, use rate code XX43) for TOTAL session. Cannot submit claims for xx42 and xx43 for same client, same day. per 15 minutes $ 25.95 $ 23.02 $ 20.79 $ 23.14 $ 20.52 $ 18.54
Family Peer Support Bachelors Level– Individual – off–site 4–8 units – Use this code to claim for entire session when session is 1 hour or more. per 15 minutes $ 21.62 $ 19.18 $ 17.33 $ 19.28 $ 17.10 $ 15.45
Family Peer Support All other allowable service personnel – Individual – Off–site – Use this code if total off–site session is 45 minutes or less (3 or less units). If session is one hour or more, use rate code XX45) for TOTAL session. Cannot submit claims for xx44 and xx45 for same client, same day. per 15 minutes $ 22.71 $ 20.14 $ 18.19 $ 20.24 $ 17.96 $ 16.22
Family Peer Support All other allowable service personnel – Individual – off–site 4–8 units – Use this code to claim for entire session when session is 1 hour or more. per 15 minutes $ 18.92 $ 16.78 $ 15.16 $ 16.87 $ 14.97 $ 13.52

*Note: In acknowledgement of the need for checks against fraud and abuse, but to ensure a client´s access to services, service utilization in excess of the annual claim limits and "soft" unit limits will be based on medical necessity and subject to post–payment review. Documentation of the medical necessity for extended durations must be kept on file in the client´s record.

**What is non–travel off–site?
Services provided off–site are paid a significantly higher rate due to the amount of practitioner time spent in travel status; therefore, Medicaid will only reimburse one off-site travel claim per day, per location. This means that if a practitioner is providing a service to more than one individual at the same location, or if multiple services requiring separate claims are being provided to one individual at an off–site location, only one off–site claim may be submitted for any services provided at that off–site location. Any subsequent claims for services provided at the same location will require that the practitioner submit a claim using the appropriate "On–site/non–travel off–site" rate code.