The Record - for physicians and other health care providers to share with their office staffs
Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
March 2013

Blue Cross Blue Shield of Michigan adds new approved autism evaluation centers

The Blues have added new centers to its list of approved autism evaluation centers. Here are the five AAECs:

  • Henry Ford Center for Autism and Developmental Disabilities, Detroit
  • Spectrum Health Medical Group, Grand Rapids
  • University of Michigan Health System, Ann Arbor
  • Oakwood Center for Exceptional Families, Dearborn
  • Children’s Hospital of Michigan Autism Center, Detroit

BCBSM health care providers can find the latest information about Blues autism coverage online. For more information, visit web-DENIS and follow these instructions:

  • Click on BCBSM Provider Publications and Resources
  • Click on Newsletters & Resources
  • Under Other Resources, click on Clinical Criteria & Resources
  • Under Resources, click on Autism

The latest list of approved autism evaluation centers (PDF) is always available on bcbsm.com. Members can find it by clicking on Find a Doctor and then Approved Autism Evaluation Centers and Board Certified Behavior Analysts (PDF), under Additional Directories.

Autism treatment billing guidelines change
In the December issue of The Record, we provided the billing and procedure information pertinent to behavior analysts who participate with the Blues to provide autism treatment. We want to update you on a change to the detailed billing guidelines for supervision quantity limits.

Behavior analysts should report supervision code G9012 in quantities per 15 minutes, with a quantity limit of 12. A board-certified behavior analyst may bill up to three hours of supervision per tutor per patient per week. A board-certified behavior analyst may bill for the supervision of the parent- and educator-tutors under this code.

We previously stated the quantity limit was calculated per hour.

The chart below has the updated detailed billing guidelines:

Activity and details

Code

Rate*

Billing

Documentation

Initial assessment

H0032

Per hour

Providers need to bill the number of units that correspond to the number of hours spent during the initial assessment.
Example: If the initial assessment takes eight hours, the provider needs to bill eight units of H0032.

Providers must document objective performance metrics in the patient record.

Reassessment
In practice, this activity may occur anywhere from monthly to annually. Reassessments are typically done on a semi-annual basis.

H0031

Per hour

Providers need to bill the number of units that correspond to the number of hours spent during the reassessment.
Example: If the reassessment takes four hours, the provider needs to bill four units of H0031.

Providers must document progress on the performance metrics established during the initial assessment in the patient record.

Line therapy
Services are provided by a tutor who needs no particular licensing or training beyond that provided by the BCBA and who may have a high school, associate’s or bachelor’s degree.

H2019

Per 15 minutes

BCBA needs to bill for the hours of direct interaction the tutors have with the member. BCBA may not bill for relatives or guardians performing tutoring services.
Because the code is per 15 minutes, provider must bill the correct number of units to correspond with the total time spent with the patient.
Example: If a member receives 2.5 hours of tutoring, the BCBA needs to bill 10 units of H2019.

NA

Supervision
Supervision is “eyes-on” during a line therapy (tutoring) session and includes time afterward to process feedback and make adjustments to the treatment plan.

G9012

Per 15 minutes

Quantity limit: BCBA may bill up to three hours per tutor per patient per week (quantity unit of 12).
BCBA may bill for the supervision of the parent- and educator-tutors under this code.

N/A

Qualified facilities can still apply for AAEC designation
The Blues continue to seek additional qualified facilities that are interested in receiving the approved autism evaluation center designation. More information can be found on web-DENIS in BCBSM Provider Publications and Resources, on our autism page.

We’re still seeking board-certified behavior analysts, too. Visit bcbsm.com/provider and follow these instructions to find the enrollment form and agreements:

  • Log in to web-DENIS.
  • Click on BCBSM Provider Publications and Resources.
  • Click on Newsletters & Resources.
  • Under Other Resources, click on Clinical Criteria & Resources.
  • Under Resources, click on Autism.

For more information, contact your provider consultant. If you’re unsure who your provider consultant is, call the appropriate manager below:

  • Southeast Michigan: Laurie Latvis, 313-225-7778
  • Mid-Michigan: Kathryn Simon, 517-325-4590
  • West and Northern Michigan: Shaun Raleigh, 616-389-8141
  • Upper Peninsula: Mike Fedrizzi, 906-228-5457
No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.