Multi-Therapy
Agencies are recognized in Kentucky Medicaid as Provider Type 76. In order
to enroll as a Multi-Therapy Agency with Kentucky Medicaid, see the Kentucky Medicaid Provider Enrollment website.
Covered Services
Multi-therapy agency service providers such as adult day health care programs, rehabilitation agencies, special health clinics and mobile health services may provide to Medicaid 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.
Verifying eligibility
Verify eligibility by contacting the automated voice response system toll free at (800) 807-1301 or use the web-based KYHealth-Net System.
Reimbursement
Reimbursement for therapy services is provided
by 907 KAR 8:045 and the Therapy Rate Schedules located on
the Fee and Rate Schedule Home Page.
A provider may request coverage for a CPT or HCPCS procedure code by submitting a request in writing to the department, which includes necessity, CPT or HCPCS code, and expected reimbursement. Any codes considered experimental are not covered by Kentucky Medicaid.
Duplication of Service
Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered, during the same time.
Prior Authorizations
Each MCO provides prior authorization for its beneficiaries.
Gainwell Technologies provides prior authorizations for fee-for-service (FFS) beneficiaries. For more information, visit Prior Authorizations.
Claims Submission
Each MCO processes its own claims.
Kentucky Medicaid contracts with Gainwell Technologies to process the Kentucky Medicaid FFS claims. For more information, visit KYHealth-Net.
Coding
Kentucky Medicaid requires Multi-Therapy Agency providers to bill on a CMS 1500 claim form utilizing the following code types where applicable:
- Current Procedure Terminology (CPT) codes, regulated by the American Medical Association (AMA).
- Healthcare Common Procedure Coding System (HCPCS) codes, regulated by the Centers for Medicare and Medicaid Services (CMS).
- Current Dental Terminology (CDT) codes, regulated by the American Dental Association (ADA).
- International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes, maintained by the Centers for Disease Control & Prevention (CDC) and the National Center for Health Statistics (NCHS).
Kentucky Medicaid uses the Medicare National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits, the Medicaid Medically Unlikely Edits (MUEs), and the McKesson Claim Check System to verify codes mutually exclusive or incidental.
Claim Appeals
Appeal
requests for denied FFS claims must be submitted to Gainwell Technologies.
The request must include the Provider Inquiry Form, reason for the appeal, and a hard copy claim.
Please refer to the member's MCO if appealing an MCO claim.
Timely Filing
Claims must be received within twelve (12) months from the date the service was provided, twelve (12) months from the date retroactive eligibility was established, or six (6) months of the Medicare adjudication date if the service was billed to Medicare.
Provider Inquiry Resources
If you cannot find the information you need or have additional questions, please direct your inquiries to:
- Billing Questions- Gainwell Technologies, (800) 807-1232, ky_provider_inquiry@gainwelltechnologies.com
- Provider Questions- (855) 824-5615
- Prior Authorization- Gainwell Technologies, (800) 292-2392, (800) 644-5725, (800) 807-8842
- Provider Enrollment, Maintenance, and Revalidation- (877) 838-5085
- KYHealth.net assistance- Gainwell Technologies, (800) 205-4696, ky_edi_helpdesk@gainwelltechnolgies.com
- Pharmacy Questions- (502) 564-6890, dmsweb@ky.gov
- Pharmacy Clinical Support Questions- (800) 477-3071
- Pharmacy Prior Authorization- (844) 336-2676
- Physician Administered Drug (PAD) list- (502) 564-6890
Managed Care Organizations
*Effective Jan. 1, 2025, Anthem is no longer an active Medicaid Managed Care Organization, or MCO, in Kentucky. However, they are responsible for the payment of claims, appeals, or disputes for dates of service up to and including Dec. 31, 2024.