Multi-therapy agencies are recognized in Kentucky Medicaid as Provider Type (76). To enroll or bill Kentucky Medicaid, multi-therapy agency services providers must be:
- Licensed in Kentucky with their respective licensing boards.
- Enrolled as active Medicaid providers and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary they serve.
Multi-therapy agency service providers such as adult day health care programs, rehabilitation agencies, special health clinics and mobile health services may provide to Meddicaid beneficiaries medically necessary occupational and physical therapy services, speech-language pathology services and comprehensive outpatient rehabilitation. To receive services, an order must be signed by a KY Medicaid participating physician, advanced practitioner registered nurse, physician assistant or psychiatrist.
A beneficiary may receive 20 rehabilitative and habilitative visits per calendar year.
A multi-therapy agency provider must meet the coverage provisions and requirements of
907 KAR 8:040 to provide covered services. All services must be performed within the scope of practice for any provider. Services covered by Kentucky Medicaid are those listed on the Speech-Language Pathologist, Occupational Therapy and Physical Therapy Rate Schedules located on the Fee and Rate Schedule page. Just because a service is listed in the administrative regulation does not guarantee payment of the service. Providers must follow Kentucky Medicaid regulations and requirements of the MCO for which it participates. All services must be medically necessary.
Verify eligibility by contacting the automated voice response system toll free at (800) 807-1301 or use the web-based KYHealth-Net System.
Reimbursement for therapy services is provided by
907 KAR 8:045 and the Therapy Rate Schedules located on the Fee and Rate Schedule page.
Duplication of Service
If a beneficiary receives services from a multi-therapy agency enrolled with Kentucky Medicaid the department will not reimburse for the same therapy service provided to the same beneficiary during the same time period via the home health program.
907 KAR 8:040 states the limits may be exceeded if services are determined to be medically necessary. Prior authorization by the department is required for each therapy service that exceeds the limit for a beneficiary not enrolled with an MCO. CareWise provides prior authorization for any fee-for-Service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Kentucky Medicaid currently contracts with
DXC to process the Kentucky Medicaid FFS claims. Each MCO processes its own claims.
KY Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes mutually exclusive or incidental. KY Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. KY Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. KY Medicaid requires the use of CMS 1500 billing forms. Providers must bill KY Medicaid using the correct CPT codes.
Appeal requests made on denied FFS claims must be submitted to
DXC. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO, if appealing an MCO claim.
Claims must be received within 12 months of the date of service or six months from the Medicare pay date, whichever is longer, or within 12 months of the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions -
DXC - (800) 807-1232
FFS Provider Questions - (855) 824-5615
Prior Authorization -
CareWise - (800) 292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance -
DXC - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drugs (PAD) list - Pharmacy Branch - (502) 564-6890
Provider MCO Information
Anthem - (800) 205-5870
Aetna Better Health of KY - (855) 300-5528
Humana - (855) 852-7005
Passport Health Plan- (800) 578-0775
WellCare of KY - (877) 389-9457