OLP Group

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
OLP –

On–site or non–travel off–site (if provider is seeing more than one individual at the same locations or providing multiple services to the same individual off–site on the same day)

Group size: 2
per 15 minutes $ 28.27 $ 25.08 $ 22.65 $ 25.21 $ 22.36 $ 20.20
OLP –

On–site or non–travel off–site (if provider is seeing more than one individual at the same locations or providing multiple services to the same individual off–site on the same day)

Group size: 3
per 15 minutes $ 21.45 $ 19.03 $ 17.18 $ 19.12 $ 16.96 $ 15.32
OLP –

On–site or non–travel off–site (if provider is seeing more than one individual at the same locations or providing multiple services to the same individual off–site on the same day)

Group size: 4
per 15 minutes $ 17.65 $ 15.65 $ 14.14 $ 15.73 $ 13.96 $ 12.61
OLP – Off–site (1 off–site claim per group – all others must use appropriate on–site rate code) Use this rate code for one off–site client regardless of group size per 15 minutes $ 74.14 $ 65.77 $ 59.40 $ 66.11 $ 58.64 $ 52.96

*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.